Provider Demographics
NPI:1952579047
Name:GREEN, HARRY ALBERT IV (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:ALBERT
Last Name:GREEN
Suffix:IV
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:103 E GATE DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08034-2803
Mailing Address - Country:US
Mailing Address - Phone:856-528-2207
Mailing Address - Fax:856-528-2437
Practice Address - Street 1:36 KRESSON RD
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08034-3227
Practice Address - Country:US
Practice Address - Phone:856-528-2207
Practice Address - Fax:856-528-2437
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-12
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00412500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical