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General NPI Number Information
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NPI Number | 1902573710
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Entity Type | Individual
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Provider Name | MISS AKALIA GREEN
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Gender | Female
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Dates
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Enumeration Date | 08/28/2021
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Last Update Date | 08/28/2021
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Provider Practice Location Address
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Address Line | 3 DEAN ST APT 1B
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City | STAMFORD
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State | CT
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Zip | 06902-6245
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Country | US
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Telephone | 203-832-5768
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Fax |
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Provider Business Mailing Address
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Address Line | 3 DEAN ST APT 1B
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City | STAMFORD
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State | CT
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Zip | 06902-6245
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Country | US
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Telephone | 203-832-5768
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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 | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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