Provider Demographics
NPI:1902390834
Name:GREEN, NEDRA YVETTE
Entity Type:Individual
Prefix:
First Name:NEDRA
Middle Name:YVETTE
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 DUPERIER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2415
Mailing Address - Country:US
Mailing Address - Phone:337-321-6691
Mailing Address - Fax:337-256-5270
Practice Address - Street 1:177 DUPERIER AVE
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70563-2415
Practice Address - Country:US
Practice Address - Phone:337-321-6691
Practice Address - Fax:337-256-5270
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2018-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty