| Organization Name: | LOGAN GREEN, PH.D. |
| NPI Number: | 1548322423 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LOGAN GREEN (NEUROPSYCHOLOGIST) |
| Mailing Address: | 494 Main St Apt 1 Cromwell |
| State: | CT US |
| Postal Code: | 064162040 |
| Phone Number: | 8606321296 |
| Fax Number: | |
| NPI Enumeration Date: | 12/15/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TF0200X |
| License Number: | 852 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Forensic |
| Taxonomy Definition: | |