Healthcare Provider Details

I. General information

NPI: 1124439286
Provider Name (Legal Business Name): BRITNEY GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2014
Last Update Date: 04/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 E 12TH ST STE 259
OAKLAND CA
94601-2940
US

IV. Provider business mailing address

3301 E 12TH ST STE 259
OAKLAND CA
94601-2940
US

V. Phone/Fax

Practice location:
  • Phone: 510-589-8599
  • Fax: 510-269-9031
Mailing address:
  • Phone: 510-589-8599
  • Fax: 510-269-9031

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: