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General NPI Number Information
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NPI Number | 1558938050
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Entity Type | Individual
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Provider Name | PETER GREEN
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Gender | Male
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 10/31/2025
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Provider Practice Location Address
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Address Line | 650 N DELAWARE ST
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City | SAN MATEO
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State | CA
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Zip | 94401-1732
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Country | US
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Telephone | 650-558-2299
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Fax | 650-762-0249
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Provider Business Mailing Address
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Address Line | 942 S FREMONT ST
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City | SAN MATEO
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State | CA
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Zip | 94402-1812
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Country | US
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Telephone | 650-533-3496
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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 | CA
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