Green Psychotherapy, PC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

GREEN PSYCHOTHERAPY, PC

Practice address

2041 Bancroft Way Ste 202
Berkeley, CA 94704-1443

Phone

(510) 612-0097

NPI assigned

Jun 6, 2019

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Douglas Vakoch, PH.D.NPI 1689233355

Title

Chief Executive Officer

Phone

(510) 612-0097

Specialties & licenses 2

Addresses

Electronic endpoints 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Douglas Vakoch, PH.D.

  • Clinical Psychologist
  • Berkeley, CA
  • NPI 1689233355
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1559779200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1578787200000",
    "number": "1366001034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1918 BONITA AVE",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947041014"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2041 BANCROFT WAY STE 202",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947041443",
            "telephone_number": "510-612-0097"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "815 Hyde St",
            "address_purpose": "LOCATION",
            "city": "San Francisco",
            "state": "CA",
            "postal_code": "941095996",
            "country_code": "US",
            "telephone_number": "510-612-0097",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2940 Summit St",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946093416",
            "country_code": "US",
            "telephone_number": "510-612-0097",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1918 Bonita Ave",
            "address_purpose": "LOCATION",
            "city": "Berkeley",
            "state": "CA",
            "postal_code": "947041014",
            "country_code": "US",
            "telephone_number": "510-612-0097",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3867 Howe St",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946115343",
            "country_code": "US",
            "telephone_number": "510-612-0097",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GREEN PSYCHOTHERAPY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-06",
        "last_updated": "2020-01-12",
        "certification_date": "2020-01-12",
        "status": "A",
        "authorized_official_last_name": "VAKOCH",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "CHIEF EXECUTIVE OFFICER",
        "authorized_official_telephone_number": "510-612-0097",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PH.D."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.greenpsychotherapy.com/contact",
            "affiliation": "N",
            "address_1": "1918 Bonita Ave",
            "city": "Berkeley",
            "state": "CA",
            "country_code": "US",
            "postal_code": "947041014",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Taisa Grant
• Deborah Machla Graudenz, MFT
• Jeremy Graves
• Anna Galadriel Gray, MSW
• Francis Elizabeth Gray, LCSW
• Cindy Green, RN
• Jonathan Greenberg
• Rachel Ada Greenberg, M.S.
• River Greenblatt, MA
• Eudice Ann Greene, LCSW

• Clinical Psychologist in Berkeley, CA
• Providers in Berkeley, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.