Active NPI
Myrna S Green, PH.D., CA LICENSED P
- Clinical Psychologist
- Palo Alto, CA
National Provider Identifier
1467529776
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY5092
- Practice address
- 440 Sherman Avenue
Suite 103
Palo Alto, CA 94306 - Phone
- (650) 328-1417
- Fax
- (650) 424-8788
- NPI assigned
- Nov 29, 2006
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY5092 | CA | Primary |
| Psychologist | 103T00000X | PSY 5092 | CA |
Addresses
Primary practice location
440 Sherman Avenue
Suite 103
Palo Alto, CA 94306
Mailing address
440 Sherman Avenue
Suite 103
Palo Alto, CA 94306
Phone (650) 328-1417
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Oct 1, 2015 through Oct 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 5092 | CA | MD | Psychologist |
| PSY5092 | CA | MD | Clinical Psychologist |
| 5092 | CA | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1482364800000",
"number": "1467529776",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "440 SHERMAN AVENUE",
"address_2": "SUITE 103",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "94306",
"telephone_number": "650-328-1417",
"fax_number": "650-424-8788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "440 SHERMAN AVENUE",
"address_2": "SUITE 103",
"city": "PALO ALTO",
"state": "CA",
"postal_code": "94306",
"telephone_number": "650-328-1417",
"fax_number": "650-424-8788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "MYRNA",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "PH.D., CA LICENSED P",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-29",
"last_updated": "2016-12-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY5092",
"primary": true
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY 5092",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Palo Alto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 22, 2016; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.