Individual
JACQUELINE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
30821 BARRINGTON ST, MADISON HEIGHTS, MI 48071-1871
(248) 965-3916
Mailing address
986 ALBERTA ST, FERNDALE, MI 48220-1627
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
—
—
103T00000X
Psychologist
6361007978
MI
103T00000X
Psychologist
Primary
—
—
106S00000X
Behavior Technician
—
—
247200000X
Other Technician
—
—
Other
Enumeration date
06/23/2016
Last updated
10/09/2024
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