Individual
ILENE GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
40 S CEDAR ST, BEACON, NY 12508-3042
(212) 222-9396
Mailing address
40 S CEDAR ST, BEACON, NY 12508-3042
(212) 222-9396
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
013226
NY
Other
Enumeration date
03/12/2024
Last updated
03/12/2024
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