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General NPI Number Information
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NPI Number | 1922203272
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Entity Type | Individual
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Provider Name | MARSHA ANN GREEN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 06/18/2007
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Last Update Date | 06/07/2016
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Provider Practice Location Address
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Address Line | 710 E FOOTHILLS DR STE C SUITE 104
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City | NEWBERG
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State | OR
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Zip | 97132-6125
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Country | US
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Telephone | 503-728-8546
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 494
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City | NEWBERG
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State | OR
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Zip | 97132-0494
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Country | US
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Telephone | 503-728-8546
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY60146929
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License Number State | WA
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