MEDICARE: DR. ANDREA CATHERINE GREEN PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY23927	CA

General Provider Information

NPI Number	:	1437345758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREA CATHERINE GREEN PSYD

Provider Business Mailing Address
First Line	:	1800 HARRISON ST FL 7
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94612-3466
Country	:	US
Telephone Number	:	510-625-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 J ST STE 360
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95814-2325
Country	:	US
Telephone Number	:	916-497-3439
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	01/11/2022

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