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General NPI Number Information
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NPI Number | 1710466685
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Entity Type | Individual
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Provider Name | DENISE A GREEN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/10/2018
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Last Update Date | 08/10/2018
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Provider Practice Location Address
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Address Line | 21 MATOON ST
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City | AMHERST
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State | MA
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Zip | 01002-2107
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Country | US
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Telephone | 413-362-1770
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Fax |
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Provider Business Mailing Address
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Address Line | 57 OLANDER DR
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City | NORTHAMPTON
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State | MA
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Zip | 01060-3631
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Country | US
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Telephone | 413-362-1770
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 6522
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 364688
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License Number State | MA
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