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General NPI Number Information
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NPI Number | 1548767858
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Entity Type | Individual
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Provider Name | ROCHELLE GREEN PHD
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Gender | Female
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Dates
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Enumeration Date | 04/12/2018
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Last Update Date | 04/12/2018
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Provider Practice Location Address
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Address Line | 111 PACIFICA STE 270
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City | IRVINE
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State | CA
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Zip | 92618-7427
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Country | US
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Telephone | 949-375-2235
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Fax |
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Provider Business Mailing Address
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Address Line | 710 CRESTVIEW CT
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City | SAN MARCOS
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State | CA
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Zip | 92078-1372
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Country | US
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Telephone | 714-213-5437
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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 | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 257RPS
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License Number State |
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