Ben Nmi Green, PHD
Individual provider Active NPI Clinical Psychologist · Madison, WI
NPI 1104882927 · NPPES record last updated Jan 19, 2011
Key facts
- NPI
- 1104882927
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 1639-57 (WI)
- Practice address
- 7617 Mineral Point Rd
Ste 300
Madison, WI 53717-1623 - Phone
- (608) 833-9290
- Fax
- (608) 833-9691
- NPI assigned
- Apr 21, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1639-57 | WI | MD | Clinical Psychologist |
| 31440-020 | WI | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| The Psychology Center S C | Current |
Accepting new patients | |
| Affiliated Counseling Center, Inc | Past |
Accepting new patients |
Locations
7617 Mineral Point Rd
Madison, WI 53717
Phone (608) 833-9290
7617 Mineral Point Rd
Ste 300
Madison, WI 53717
Phone (608) 833-9290
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 31440-020 | WI | |
| Clinical Psychologist | 103TC0700X | 1639-57 | WI | Yes |
Addresses
Primary practice location
7617 Mineral Point Rd
Ste 300
Madison, WI 53717-1623
Mailing address
7617 Mineral Point Rd
Ste 300
Madison, WI 53717-1623
Phone (608) 833-9290
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39088700 | Medicaid | WI |
Other providers in Madison, WI
- Margaret M. Greco
- Karen Grede
- Karen Rose Gredler
- Green Cab of Madison Inc
- Stephanie Green-Schlafer
- Carolyn Ruth Green
- Cynthia C Green
- Deirdre Dea Green
- Ellen Walford Green
- Judith N Green
All providers in Madison, WI · Clinical Psychologist in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 19, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.