Healthcare Provider Details

I. General information

NPI: 1902308240
Provider Name (Legal Business Name): PHYLLIS GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2018
Last Update Date: 06/24/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2780 SW 37TH AVE STE 206
COCONUT GROVE FL
33133-2740
US

IV. Provider business mailing address

2780 SW 37TH AVE STE 206
COCONUT GROVE FL
33133-2740
US

V. Phone/Fax

Practice location:
  • Phone: 305-646-0112
  • Fax:
Mailing address:
  • Phone: 305-646-0112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0701013085
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: