Healthcare Provider Details

I. General information

NPI: 1336363357
Provider Name (Legal Business Name): KRISTEN NICOLE GREEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCLA STUDENT PSYCHOLOGICAL SERVICES JOHN WOODEN WEST BX 951556
LOS ANGELES CA
90095-1556
US

IV. Provider business mailing address

UCLA STUDENT PSYCHOLOGICAL SERVICES JOHN WOODEN WEST BX 951556
LOS ANGELES CA
90095-1556
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-0768
  • Fax: 310-206-7365
Mailing address:
  • Phone: 310-825-0768
  • Fax: 310-206-7365

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY 21353
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: