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General NPI Number Information
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NPI Number | 1629451588
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Entity Type | Individual
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Provider Name | FREDERICK WILLIAM GREEN III PSYD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2015
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Last Update Date | 08/25/2023
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Provider Practice Location Address
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Address Line | 51 FAIRVIEW AVE
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City | REHOBOTH
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State | MA
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Zip | 02769-2003
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Country | US
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Telephone | 207-317-0557
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Fax |
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Provider Business Mailing Address
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Address Line | 51 FAIRVIEW AVE
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City | REHOBOTH
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State | MA
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Zip | 02769-2003
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Country | US
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Telephone | 207-317-0557
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS01612
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License Number State | RI
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 3489
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 11457
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License Number State | MA
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