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General NPI Number Information
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NPI Number | 1447772496
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Entity Type | Individual
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Provider Name | DAVID N GREEN PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/12/2017
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Last Update Date | 07/12/2017
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Provider Practice Location Address
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Address Line | 19 W 34TH ST PH
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City | NEW YORK
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State | NY
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Zip | 10001-3006
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Country | US
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Telephone | 646-926-7740
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Fax |
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Provider Business Mailing Address
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Address Line | 3801 HUDSON MANOR TER APT 7K
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City | BRONX
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State | NY
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Zip | 10463-1108
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Country | US
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Telephone |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 022076-1
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License Number State | NY
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