Active NPI
Linda T Green, PSYD
- Clinical Psychologist
- West Bloomfield, MI
National Provider Identifier
1881683050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 6301005056
- Practice address
- 1591 Furnwall St
West Bloomfield, MI 48324-3824 - Phone
- (248) 258-8899
- Fax
- (248) 287-4633
- NPI assigned
- Oct 19, 2005
- 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 | 6301005056 | MI | Primary |
| School Psychologist | 103TS0200X | MI |
Addresses
Primary practice location
1591 Furnwall St
West Bloomfield, MI 48324-3824
Mailing address
1591 Furnwall St
West Bloomfield, MI 48324-3824
Phone (248) 258-8899
Other identifiers 5
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7215028 | Other | MI | AETNA |
| 11277424 | Other | MI | CAQH |
| 298871000 | Other | MI | MAGELLAN |
| 620F348200 | Other | MI | BCBS |
| 119609 | Other | MI | VALUE OPTIONS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 1, 2023 through Jan 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1129680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1644883200000",
"number": "1881683050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1591 FURNWALL ST",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483243824",
"telephone_number": "248-258-8899",
"fax_number": "248-287-4633"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1591 FURNWALL ST",
"city": "WEST BLOOMFIELD",
"state": "MI",
"postal_code": "483243824",
"telephone_number": "248-258-8899",
"fax_number": "248-287-4633"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "LINDA",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2005-10-19",
"last_updated": "2022-02-15",
"certification_date": "2022-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MI",
"license": "6301005056",
"primary": true
},
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": "MI",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "7215028",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CAQH",
"identifier": "11277424",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "298871000",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "620F348200",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "119609",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in West Bloomfield, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.