Jilda S Green, PH D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PS016428 Issued in PA

Practice address

4641 Roosevelt Blvd
Philadelphia, PA 19124-2343

Phone

(215) 831-2896

Fax

(215) 831-2929

NPI assigned

Aug 23, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1990

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Delaware County Professional Services, IncGroup PAC ID 2668436692, 276 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Delaware County Professional Services, Inc

  dba LifeStance

  • Psychiatry Physician
  • Media, PA
  • NPI 1952485864
  Medicare reassignment Care Compare group NPD
• Family Practice & Counseling Services Network, Inc.

  • Federally Qualified Health Center (FQHC)
  • Philadelphia, PA
  • NPI 1043204811
  NPD (past)

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

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731196800000",
    "number": "1740473792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4641 ROOSEVELT BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191242343",
            "telephone_number": "215-831-2896",
            "fax_number": "215-831-2929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4641 ROOSEVELT BLVD",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191242343",
            "telephone_number": "215-831-2896",
            "fax_number": "215-831-2929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "JILDA",
        "middle_name": "S",
        "name_prefix": "Ms.",
        "credential": "PH D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-08-23",
        "last_updated": "2024-11-10",
        "certification_date": "2024-11-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "PA",
            "license": "PS016428",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "PA",
            "license": "PS016428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Green, LCSW
• Elizabeth Marie Green, PA-C
• Jason Lamont Green
• Jenelle Green
• Jesse Andrew Green, MD
• Jordan Lilyanna Green
• Julia Green
• Julie Lynne Green, MSPT, OCS
• Kathryn Laura Green
• Kelly Green, PH.D.

• Psychologist in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Psychologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 10, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.