Provider Demographics
NPI:1295589323
Name:GREEN, PATRICIA ARNETTE (LMFT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ARNETTE
Last Name:GREEN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 BROOKSHIRE ST
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5552
Mailing Address - Country:US
Mailing Address - Phone:650-218-3365
Mailing Address - Fax:
Practice Address - Street 1:130 E LELAND RD STE C
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-4954
Practice Address - Country:US
Practice Address - Phone:925-384-3997
Practice Address - Fax:925-252-1618
Is Sole Proprietor?:No
Enumeration Date:2024-04-15
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143460101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor