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GREEN ROOM PSYCHOLOGY SERVICES INCORPORATION NPI 1811263957


NPI Information

NPI: 1811263957
Provider Name: GREEN ROOM PSYCHOLOGY SERVICES INCORPORATION
Classification: Specialist - 174400000X
Entity Type: Organization
Address:
5252 BALBOA AVE
SUITE 204
SAN DIEGO, CA
ZIP 92117
Phone: (858) 480-9118
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GREEN ROOM PSYCHOLOGY SERVICES INCORPORATION is a specialist in San Diego, CA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. GREEN ROOM PSYCHOLOGY SERVICES INCORPORATION NPI is 1811263957. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

5252 BALBOA AVE
SUITE 204
SAN DIEGO, CA
ZIP 92117-906
Phone: (858) 480-9118
Fax: (858) 712-9035

The provider's authorized official is Neda Khodaparast .
The authorized official title is Ceo and has the following contact phone number (858) 480-9118.

The enumeration date for this NPI number is 3/22/2012 and was last updated on 3/24/2017.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialist23114CALIFORNIAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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