Active NPI
Wesley Green
- Intellectual & Developmental Disabilities Psychologist
- Mount Dora, FL
National Provider Identifier
1962012310
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Intellectual & Developmental Disabilities Psychologist
- Practice address
- 3340 Lake Center Dr Apt 12107
Mount Dora, FL 32757-2378 - Phone
- (352) 800-9172
- NPI assigned
- Jul 31, 2020
- 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 |
|---|---|---|---|---|
| Intellectual & Developmental Disabilities Psychologist | 103TM1800X | Primary |
Addresses
Primary practice location
3340 Lake Center Dr Apt 12107
Mount Dora, FL 32757-2378
Mailing address
3340 Lake Center Dr Apt 12107
Mount Dora, FL 32757-2378
Phone (352) 800-9172
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": "1596153600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1596153600000",
"number": "1962012310",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3340 LAKE CENTER DR APT 12107",
"city": "MOUNT DORA",
"state": "FL",
"postal_code": "327572378",
"telephone_number": "352-800-9172"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3340 LAKE CENTER DR APT 12107",
"city": "MOUNT DORA",
"state": "FL",
"postal_code": "327572378",
"telephone_number": "352-800-9172"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "WESLEY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-07-31",
"last_updated": "2020-07-31",
"certification_date": "2020-07-31",
"status": "A"
},
"taxonomies": [
{
"code": "103TM1800X",
"taxonomy_group": "",
"desc": "Psychologist, Intellectual & Developmental Disabilities",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mount Dora, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.