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General NPI Number Information
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NPI Number | 1851689418
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Entity Type | Organization
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Legal Business Name | SUZANNE E GREEN PHD PA
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Dates
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Enumeration Date | 07/18/2011
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Last Update Date | 11/29/2011
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Provider Practice Location Address
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Address Line | 4399 N NOB HILL RD
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City | SUNRISE
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State | FL
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Zip | 33351-5813
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Country | US
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Telephone | 954-746-8415
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Fax | 954-370-5967
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Provider Business Mailing Address
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Address Line | 2921 W ABIACA CIR
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City | DAVIE
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State | FL
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Zip | 33328-7134
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUZANNE E GREEN
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Credential | PHD, PA
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Telephone | 954-146-8415
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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 | PY5213
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License Number State | FL
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