Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 88897 | CA |
NPI | 1003214792 |
---|---|
Provider Name | Kaitlyn Marie Green |
First Address | Redding, CA 96002-1455 |
Second Address | Redding, CA 96002-1455 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/12/2014 |
Last Update Date | 29/11/2021 |