Provider Demographics
NPI:1982226387
Name:GREEN, ELIZABETH SOKOLIK (PSYD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SOKOLIK
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 1:26 SEVILLE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-2831
Mailing Address - Country:US
Mailing Address - Phone:650-906-7489
Mailing Address - Fax:
Practice Address - Street 1:26 SEVILLE WAY
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-2831
Practice Address - Country:US
Practice Address - Phone:650-906-7489
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-08
Last Update Date:2020-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30731103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty