Provider Demographics
NPI:1407203540
Name:GREEN, MARGARET MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARGARET
Middle Name:MARIE
Last Name:GREEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1482
Mailing Address - Street 2:
Mailing Address - City:HAYDEN
Mailing Address - State:ID
Mailing Address - Zip Code:83835-1482
Mailing Address - Country:US
Mailing Address - Phone:208-907-6441
Mailing Address - Fax:208-209-6011
Practice Address - Street 1:7905 N MEADOWLARK WAY STE E
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-5041
Practice Address - Country:US
Practice Address - Phone:208-907-6441
Practice Address - Fax:208-209-6011
Is Sole Proprietor?:No
Enumeration Date:2016-05-18
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID202941103TC0700X
WAPY60655201103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical