Doctor Name: | JOHN ROBERT GREEN |
NPI Number: | 1326120478 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.C.S.W. |
License Number: | LT11036 |
Business Practice Address: | 7738 W 80th St Playa Del Rey, CA - 902937972 |
Business Phone Number: | 3108222782 |
Business Fax Number: | 3105338019 |
Mailing Address: | 7738 W 80th St, PLAYA DEL REY |
State: | CA |
Postal Code: | 902937972 |
Phone Number: | 3108222782 |
Fax Number: | 3105338019 |
NPI Enumeration Date: | 10/19/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | LT11036 |
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 |