Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 35SI00202600 | NJ |
N | 103T00000X | Psychologist | 35SI00202600 | NJ |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 35SI00202600 | NJ |
N | 103G00000X | Clinical Psychologist | 35SI00202600 | NJ |
N | 103TC0700X | Clinical Psychologist | 35SI00202600 | NJ |
N | 103TH0100X | Health Service | 35SI00202600 | NJ |
NPI | 1194820464 |
---|---|
Provider Name | Leon Green |
First Address | East Brunswick, NJ 08816 |
Second Address | East Brunswick, NJ 08816 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2006 |
Last Update Date | 08/07/2007 |