Individual
DR. KIMBERLEY A GREEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D., HSPP
Contact information
Practice address
1 UNIVERSITY BLVD, COMMUNITY PSYCHOLOGICAL SERVICE, 232 STADLER HALL, SAINT LOUIS, MO 63121-4400
(314) 516-5824
(314) 516-5347
Mailing address
1 UNIVERSITY BLVD, COMMUNITY PSYCHOLOGICAL SERVICE, SAINT LOUIS, MO 63121-4400
(314) 516-5824
(314) 516-5347
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
20040602
IN
103TH0100X
Health Service Psychologist
Primary
20040602
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000533237
ANTHEM BC/BS
—
01
—
06010200
MAGELLAN HEALTH SERVICES
—
01
—
084081
SIHO - SOUTHEASTERN INDIANA HEALTH ORGANIZATION
—
05
—
100167180A
—
IN
01
—
7453298
AETNA
—
Enumeration date
09/20/2005
Last updated
11/26/2012
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