Doctor Name: | DR. SETH GREEN |
NPI Number: | 1053595371 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 687 |
Business Practice Address: | 607 Division Street Nome, AK - 997620966 |
Business Phone Number: | 9074433344 |
Business Fax Number: | |
Mailing Address: | Po Box 966, NOME |
State: | AK |
Postal Code: | 997620966 |
Phone Number: | 9074433344 |
Fax Number: | |
NPI Enumeration Date: | 12/21/2007 |
NPI Last Update Date: | 05/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 687 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |