Healthcare Provider Details

I. General information

NPI: 1275486755
Provider Name (Legal Business Name): KAITLYN GREEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/16/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

325 STREET RD
SOUTHAMPTON PA
18966-3109
US

IV. Provider business mailing address

405 FEDERAL LN
MORRISVILLE PA
19067-4920
US

V. Phone/Fax

Practice location:
  • Phone: 215-645-0338
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC020305
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: