Individual
PATRICIA ANN GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
5201 RAYMOND ST, ORLANDO, FL 32803-8208
(407) 629-1599
Mailing address
5201 RAYMOND ST, ORLANDO, FL 32803-8208
(407) 629-1599
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PY 7091
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
74047
BLUE CROSS BLUE SHIELD
FL
Enumeration date
06/26/2006
Last updated
10/28/2010
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