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General NPI Number Information
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NPI Number | 1730240474
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Entity Type | Individual
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Provider Name | NANCY ELLEN GREENE PHD
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Gender | Female
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Dates
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Enumeration Date | 12/13/2006
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Last Update Date | 09/11/2025
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Provider Practice Location Address
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Address Line | 2442 FOURTH AVENUE
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City | SAN DIEGO
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State | CA
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Zip | 92101
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Country | US
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Telephone | 619-234-1988
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Fax | 619-232-6052
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Provider Business Mailing Address
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Address Line | 2442 FOURTH AVENUE
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City | SAN DIEGO
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State | CA
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Zip | 92101
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Country | US
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Telephone | 619-234-1988
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Fax | 619-232-6052
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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 | PSY 6176
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 14659
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | SP191
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License Number State | CA
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