Provider Demographics
NPI:1740608876
Name:GREEN, JUDITH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 BOULEVARD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1742
Mailing Address - Country:US
Mailing Address - Phone:973-321-4380
Mailing Address - Fax:
Practice Address - Street 1:420 BOULEVARD
Practice Address - Street 2:SUITE 101
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1742
Practice Address - Country:US
Practice Address - Phone:973-321-4380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-05
Last Update Date:2014-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00408800103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist