Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY 11858 | CA |
NPI | 1205993029 |
---|---|
Provider Name | Dr. Margot Green |
First Address | Walnut Creek, CA 94596-5318 |
Second Address | Walnut Creek, CA 94596-5318 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 30/12/2021 |