Active NPI
Steven Michael Green
- Clinical Psychologist
- Represa, CA
National Provider Identifier
1407286008
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 27523
- Practice address
- 100 Prison Rd
Represa, CA 95671-3000 - Phone
- (202) 509-3211
- NPI assigned
- Nov 18, 2013
- Last updated
- May 26, 2022
- Sex
- Male
- 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 | 27523 | CA | Primary |
Addresses
Primary practice location
100 Prison Rd
Represa, CA 95671-3000
Mailing address
115 E Broadway
Apt. L105
San Gabriel, CA 91776-1890
Phone (202) 509-3211
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1384732800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653523200000",
"number": "1407286008",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "115 E BROADWAY",
"address_2": "APT. L105",
"city": "SAN GABRIEL",
"state": "CA",
"postal_code": "917761890",
"telephone_number": "202-509-3211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 PRISON RD",
"city": "REPRESA",
"state": "CA",
"postal_code": "956713000",
"telephone_number": "202-509-3211"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "STEVEN",
"middle_name": "MICHAEL",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2013-11-18",
"last_updated": "2022-05-26",
"certification_date": "2022-05-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "27523",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Represa, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.