Individual
JENNIE ELIZABETH GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSY.D.
Contact information
Practice address
3200 MOTOR AVE, LOS ANGELES, CA 90034-3710
(310) 204-1666
Mailing address
3200 MOTOR AVE, LOS ANGELES, CA 90034-3710
(310) 204-1666
Taxonomy
Speciality
Code
Description
License number
State
103TC2200X
Clinical Child & Adolescent Psychologist
Primary
—
—
Other
Enumeration date
10/05/2011
Last updated
12/02/2013
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