Individual
DR. LESLIE WEISS GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
755 W BIG BEAVER RD, SUITE 414, TROY, MI 48084-4900
(248) 593-0678
(248) 593-9766
Mailing address
PO BOX 1563, TROY, MI 48099-1563
(248) 593-0678
(248) 593-9766
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
6301005638
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
620F33143
BLUE CROSS PIN
MI
Enumeration date
03/13/2007
Last updated
07/08/2007
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