Active NPI
Susan Marinel Greene, PH.D.
- Clinical Psychologist
- El Cerrito, CA
National Provider Identifier
1346334711
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY6684
- Practice address
- 11100 San Pablo Ave
Suite 216
El Cerrito, CA 94530-2194 - Phone
- (510) 233-8402
- Fax
- (510) 233-8402
- NPI assigned
- Oct 3, 2006
- Last updated
- Jul 8, 2007
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY6684 | CA | Primary |
Addresses
Primary practice location
11100 San Pablo Ave
Suite 216
El Cerrito, CA 94530-2194
Mailing address
11100 San Pablo Ave
Suite 216
El Cerrito, CA 94530-2194
Phone (510) 233-8402
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PSY066840 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160209002467 | CA | Practitioner - Clinical Psychologist | 9931403151 | Practice locations: El Cerrito, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6684 | CA | MD | Addiction (Substance Use Disorder) Counselor |
| PSY6684 | CA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159833600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1346334711",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11100 SAN PABLO AVE",
"address_2": "SUITE 216",
"city": "EL CERRITO",
"state": "CA",
"postal_code": "945302194",
"telephone_number": "510-233-8402",
"fax_number": "510-233-8402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11100 SAN PABLO AVE",
"address_2": "SUITE 216",
"city": "EL CERRITO",
"state": "CA",
"postal_code": "945302194",
"telephone_number": "510-233-8402",
"fax_number": "510-233-8402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREENE",
"first_name": "SUSAN",
"middle_name": "MARINEL",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-03",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY6684",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "PSY066840",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in El Cerrito, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.