Provider Demographics
NPI:1770372831
Name:GREEN, MERYL (AMFT)
Entity type:Individual
Prefix:
First Name:MERYL
Middle Name:
Last Name:GREEN
Suffix:
Gender:
Credentials:AMFT
Other - Prefix:
Other - First Name:MILO
Other - Middle Name:
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1110 N VIRGIL AVE
Mailing Address - Street 2:PMB 93878
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90029
Mailing Address - Country:US
Mailing Address - Phone:310-695-7517
Mailing Address - Fax:
Practice Address - Street 1:1110 N VIRGIL AVE
Practice Address - Street 2:PMB 93878
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029
Practice Address - Country:US
Practice Address - Phone:310-695-7517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health