Provider Demographics
NPI:1962504472
Name:GREEN, BARBARA (PHD)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 DERBY ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-4007
Mailing Address - Country:US
Mailing Address - Phone:781-749-9227
Mailing Address - Fax:781-740-0233
Practice Address - Street 1:175 DERBY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-4007
Practice Address - Country:US
Practice Address - Phone:781-749-9227
Practice Address - Fax:781-740-0233
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3063103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03281Medicare UPIN