Provider Demographics
NPI:1386780716
Name:GREEN, DANIELLE (PHD)
Entity type:Individual
Prefix:DR
First Name:DANIELLE
Middle Name:
Last Name:GREEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 JULIA PL
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236-6915
Mailing Address - Country:US
Mailing Address - Phone:941-355-2258
Mailing Address - Fax:941-362-3186
Practice Address - Street 1:405 JULIA PL
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-6915
Practice Address - Country:US
Practice Address - Phone:941-355-2258
Practice Address - Fax:941-362-3186
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT0001550106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist