Individual
DR. PAMELA GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
11325 LAKE UNDERHILL RD STE 101, ORLANDO, FL 32825-5090
(407) 365-2599
(407) 365-3132
Mailing address
PO BOX 5377, WINTER PARK, FL 32793-5377
(407) 365-2599
(407) 365-3132
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PY0002246
FL
103TA0700X
Adult Development & Aging Psychologist
PY0002246
FL
103TC0700X
Clinical Psychologist
Primary
PY0002246
FL
103TF0200X
Forensic Psychologist
PY0002246
FL
103TH0100X
Health Service Psychologist
PY0002246
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009418900
—
FL
05
—
209749400
—
FL
Enumeration date
04/25/2007
Last updated
02/07/2019
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