Active NPI
Jennifer A Green, ED.S.
- Psychologist
- North Charleston, SC
National Provider Identifier
1124363684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 102627
- Practice address
- 5431 Clairmont LN
North Charleston, SC 29420-7810 - Phone
- (843) 821-3973
- NPI assigned
- Dec 10, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 102627 | SC | Primary |
Addresses
Primary practice location
5431 Clairmont LN
North Charleston, SC 29420-7810
Mailing address
5431 Clairmont LN
North Charleston, SC 29420-7810
Phone (843) 821-3973
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 102627 | SC | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1355097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1355097600000",
"number": "1124363684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5431 CLAIRMONT LN",
"city": "NORTH CHARLESTON",
"state": "SC",
"postal_code": "294207810",
"telephone_number": "843-821-3973"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5431 CLAIRMONT LN",
"city": "NORTH CHARLESTON",
"state": "SC",
"postal_code": "294207810",
"telephone_number": "843-821-3973"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "JENNIFER",
"middle_name": "A",
"name_prefix": "Ms.",
"credential": "ED.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-12-10",
"last_updated": "2012-12-10",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "SC",
"license": "102627",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in North Charleston, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.