Provider Demographics
NPI:1376657395
Name:CRITTON-GREEN, BARBARA LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:LEE
Last Name:CRITTON-GREEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BARBARA
Other - Middle Name:LEE
Other - Last Name:CRITTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6111 HARRISON STREET
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-2972
Mailing Address - Country:US
Mailing Address - Phone:219-730-7773
Mailing Address - Fax:219-455-6231
Practice Address - Street 1:6111 HARRISON ST
Practice Address - Street 2:SUITE 204
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2972
Practice Address - Country:US
Practice Address - Phone:219-730-7773
Practice Address - Fax:219-455-6231
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040724A103TC0700X
IN20040724103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200034070BMedicaid
IN200034070CMedicaid
IN200034070DMedicaid
IN200034070BMedicaid