Sydjea M Green, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

39576 Issued in TX

Practice address

1230 N Kimball Ave Ste 130
Southlake, TX 76092-4707

Phone

(833) 667-7924

Fax

(817) 755-0945

NPI assigned

Sep 21, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1663718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1750004248",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 FLOYD ST",
            "city": "BRENTWOOD",
            "state": "NY",
            "postal_code": "117172646",
            "telephone_number": "631-336-0695"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 N KIMBALL AVE STE 130",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "760924707",
            "telephone_number": "833-667-7924",
            "fax_number": "817-755-0945"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GREEN",
        "first_name": "SYDJEA",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-09-21",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "TX",
            "license": "39576",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Green Birdd Freight LLC
• Green Hills Associates PLLC
• Andrew Green, DPT
• Connie Laverne Green
• Edward Aric Green
• Latasha D Greene
• William Greenlee, DC
• Destinee Nichole Greenwell, LPC, LCDC
• Nikita Greenwood, FNP
• Greer Dermatology, PLLC

• Psychologist in Southlake, TX
• Providers in Southlake, TX by specialty
• Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 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.

Verify at the official NPI Registry.