Healthcare Provider Details

I. General information

NPI: 1699087643
Provider Name (Legal Business Name): REGINA GREEN PMHCNS, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2010
Last Update Date: 07/07/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 BROWNING LN SUITE C5
CHERRY HILL NJ
08003-3195
US

IV. Provider business mailing address

102 BROWNING LN SUITE C5
CHERRY HILL NJ
08003-3195
US

V. Phone/Fax

Practice location:
  • Phone: 856-571-4425
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number26NJ00112000
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: