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NPI Profile for LARESA GREEN in ECORSE, MI.
A psychologist, certified/licensed at the independent practice level in his/her state, who is duly trained and experienced in the delivery of direct, preventative, assessment, and therapeutic intervention services to individuals whose growth, adjustment, or functioning is actually impaired or is demonstrably at high risk of impairment (1974).
Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Health Service |
103TH0100X | 62 | Psychologist, Clinical |
| NPI # | 1841034295 |
|
| Status | Active | |
| Credentials | ||
| Entity | Individual | |
| Enumeration date | 06/20/2024 | |
| Last updated | 06/20/2024 - More than a year ago | |
| Sole proprietor 1 | No | |
| Identifiers | Not Available | |
| Hospital affiliation(s) | Not Available |
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LARESA GREEN