Provider Demographics
NPI:1184933947
Name:GREEN, KAREN M (PSYD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:M
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 1:38 STEWART AVE
Mailing Address - Street 2:STEWART MANOR SCHOOL
Mailing Address - City:STEWART MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:11530
Mailing Address - Country:US
Mailing Address - Phone:516-326-5530
Mailing Address - Fax:516-326-0548
Practice Address - Street 1:38 STEWART AVE.
Practice Address - Street 2:
Practice Address - City:STEWART MANOR
Practice Address - State:NY
Practice Address - Zip Code:11530
Practice Address - Country:US
Practice Address - Phone:516-326-5530
Practice Address - Fax:516-326-0548
Is Sole Proprietor?:No
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013227103TC2200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent