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Individual

DR. LINDA T GREEN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
PSYD

Contact information

Practice address
1591 FURNWALL ST, WEST BLOOMFIELD, MI 48324-3824
(248) 258-8899
(248) 287-4633
Mailing address
1591 FURNWALL ST, WEST BLOOMFIELD, MI 48324-3824
(248) 258-8899
(248) 287-4633

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
6301005056
MI
103TS0200X
School Psychologist
MI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
11277424
CAQH
MI
01
119609
VALUE OPTIONS
MI
01
298871000
MAGELLAN
MI
01
620F348200
BCBS
MI
01
7215028
AETNA
MI
Enumeration date
10/19/2005
Last updated
02/15/2022
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