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General NPI Number Information
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NPI Number | 1235925892
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Entity Type | Individual
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Provider Name | LISA GREEN
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Gender | Female
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Dates
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Enumeration Date | 04/18/2025
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Last Update Date | 04/18/2025
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Provider Practice Location Address
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Address Line | 790 E MARKET ST
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City | WEST CHESTER
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State | PA
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Zip | 19382-4806
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Country | US
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Telephone | 610-290-8566
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Fax |
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Provider Business Mailing Address
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Address Line | 275 S BRYN MAWR AVE APT D13
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City | BRYN MAWR
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State | PA
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Zip | 19010-4215
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Country | US
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Telephone | 610-716-8402
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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