Provider Demographics
NPI:1922351782
Name:GREEN, VICTORIA (MA)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:ELIZABETH
Other - Middle Name:VICTORIA
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:95 MCCOPPIN ST APT E305
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-5402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3637 SACRAMENTO ST STE F
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1726
Practice Address - Country:US
Practice Address - Phone:415-974-9322
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-18
Last Update Date:2012-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32410106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist