MEDICARE: DR. JUDITH LEMPERT GREEN PH.D.

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	001670	MI
2	103TC2200X	Clinical Child & Adolescent Psychologist	001670	MI
3	103T00000X	Psychologist	001670	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	001670	OTHER	MI	PSYCHOLOGIST LICENSE
2	11277419	OTHER		CAQH PROVIDER #
3	620H14645	OTHER	MI	BCBSM PROVIDER

General Provider Information

NPI Number	:	1588751887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH LEMPERT GREEN PH.D.

Provider Business Mailing Address
First Line	:	2311 E STADIUM BLVD
Second Line	:	#106
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-4833
Country	:	US
Telephone Number	:	734-665-2860
Fax Number	:

Provider Business Practice Location Address
First Line	:	2311 E STADIUM BLVD
Second Line	:	#105N, OFFICE 6
City	:	ANN ARBOR
State	:	MI
Zip	:	48104-4833
Country	:	US
Telephone Number	:	734-665-2860
Fax Number	:

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	09/11/2025

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Directions to “ DR. JUDITH LEMPERT GREEN PH.D.” Practice Location

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