Individual
MS. JILDA S GREEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH D
Contact information
Practice address
4641 ROOSEVELT BLVD, PHILADELPHIA, PA 19124-2343
(215) 831-2896
(215) 831-2929
Mailing address
4641 ROOSEVELT BLVD, PHILADELPHIA, PA 19124-2343
(215) 831-2896
(215) 831-2929
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PS016428
PA
103TM1800X
Intellectual & Developmental Disabilities Psychologist
PS016428
PA
Other
Enumeration date
08/23/2007
Last updated
11/10/2024
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