MEDICARE: ERIN JOVAN GREEN BA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1508997974
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIN JOVAN GREEN BA

Provider Business Mailing Address
First Line	:	447 N EL MOLINO AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91101-1403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3939 ATLANTIC AVE STE 103
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-3529
Country	:	US
Telephone Number	:	562-264-6001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	04/20/2026

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