Provider Demographics
NPI:1285912006
Name:GREEN, GENEVIEVE ANN (MFTI)
Entity type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:ANN
Last Name:GREEN
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5059 HILLER LN
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-8601
Mailing Address - Country:US
Mailing Address - Phone:415-412-0336
Mailing Address - Fax:
Practice Address - Street 1:202 GLACIER DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4826
Practice Address - Country:US
Practice Address - Phone:415-412-0336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-27
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63340106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist