Provider Demographics
NPI:1841441938
Name:DAVID GREEN, PH.D. & LOUISE GREEN, PH.D., APC
Entity type:Organization
Organization Name:DAVID GREEN, PH.D. & LOUISE GREEN, PH.D., APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LOUISE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:619-281-0616
Mailing Address - Street 1:5333 MISSION CENTER RD
Mailing Address - Street 2:SUITE 354
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1302
Mailing Address - Country:US
Mailing Address - Phone:619-281-0616
Mailing Address - Fax:619-528-1263
Practice Address - Street 1:5333 MISSION CENTER RD
Practice Address - Street 2:SUITE 354
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1302
Practice Address - Country:US
Practice Address - Phone:619-281-0616
Practice Address - Fax:619-528-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4696103TC0700X
CAPSY4422103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty