| Doctor Name: | TANSANETA D GREEN |
| NPI Number: | 1306020755 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | MSW |
| License Number: | 16130 |
| Business Practice Address: | 35225 Avenue A Ste 101 Yucaipa, CA - 923994359 |
| Business Phone Number: | 9097908603 |
| Business Fax Number: | 9097908618 |
| Mailing Address: | 35225 Avenue A Ste 101, YUCAIPA |
| State: | CA |
| Postal Code: | 923994359 |
| Phone Number: | 9097908603 |
| Fax Number: | 9097908618 |
| NPI Enumeration Date: | 12/20/2007 |
| NPI Last Update Date: | 12/20/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 16130 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |