Provider Demographics
NPI:1295321321
Name:GREEN, KRYSTINA (MA)
Entity type:Individual
Prefix:
First Name:KRYSTINA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7413 FALCON ST
Mailing Address - Street 2:
Mailing Address - City:NEW TRIPOLI
Mailing Address - State:PA
Mailing Address - Zip Code:18066-3958
Mailing Address - Country:US
Mailing Address - Phone:610-509-9911
Mailing Address - Fax:
Practice Address - Street 1:7413 FALCON ST
Practice Address - Street 2:
Practice Address - City:NEW TRIPOLI
Practice Address - State:PA
Practice Address - Zip Code:18066-3958
Practice Address - Country:US
Practice Address - Phone:610-509-9911
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-13
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional