Provider Demographics
NPI:1336363357
Name:GREEN, KRISTEN NICOLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:NICOLE
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:UCLA STUDENT PSYCHOLOGICAL SERVICES
Mailing Address - Street 2:JOHN WOODEN WEST BX 951556
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1556
Mailing Address - Country:US
Mailing Address - Phone:310-825-0768
Mailing Address - Fax:310-206-7365
Practice Address - Street 1:UCLA STUDENT PSYCHOLOGICAL SERVICES
Practice Address - Street 2:JOHN WOODEN WEST BX 951556
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-1556
Practice Address - Country:US
Practice Address - Phone:310-825-0768
Practice Address - Fax:310-206-7365
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21353103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling