Healthcare Provider Details

I. General information

NPI: 1881721215
Provider Name (Legal Business Name): CYNTHIA RACHEL GREEN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 ERWIN PARK
MONTCLAIR NJ
07042-3017
US

IV. Provider business mailing address

1 ERWIN PARK
MONTCLAIR NJ
07042-3017
US

V. Phone/Fax

Practice location:
  • Phone: 973-655-0422
  • Fax:
Mailing address:
  • Phone: 973-610-4414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number011026-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: