Individual
ELIZA LIDIE GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1080 N DELAWARE AVE, PHILADELPHIA, PA 19125-4330
(804) 887-0643
Mailing address
1080 N DELAWARE AVE, PHILADELPHIA, PA 19125-4330
(215) 496-0707
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
PC016375
PA
Other
Enumeration date
12/27/2023
Last updated
01/11/2024
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