Provider Demographics
NPI:1932627023
Name:GREEN, SOROYA
Entity Type:Individual
Prefix:
First Name:SOROYA
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SOROYA
Other - Middle Name:
Other - Last Name:BLUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:651 E TRAVIS BLVD APT 73
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5391
Mailing Address - Country:US
Mailing Address - Phone:707-205-5650
Mailing Address - Fax:
Practice Address - Street 1:137 N COTTONWOOD ST STE 1500
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-6646
Practice Address - Country:US
Practice Address - Phone:530-666-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-08
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker