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General NPI Number Information
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NPI Number | 1285058610
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Entity Type | Individual
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Provider Name | CLIFFORD CHILDS GREEN PSYD, LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/05/2014
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 2211 ALA WAI BLVD APT 2101
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City | HONOLULU
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State | HI
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Zip | 96815-2405
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Country | US
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Telephone | 808-256-6119
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Fax |
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Provider Business Mailing Address
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Address Line | 2211 ALA WAI BLVD APT 2101
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City | HONOLULU
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State | HI
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Zip | 96815-2405
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Country | US
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Telephone | 808-256-6119
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW-4581
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License Number State | HI
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Taxonomy #2
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | LSW-2093
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License Number State | HI
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