Green, Bernard L
Green, Bernard L is an individual health care provider with primary practice located at 1531 S Madison St , Appleton WI 54915-1800. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Green, Bernard L can be contacted via phone (920) 730-4411.Contact Information
Primary practice address
1531 S Madison St
Appleton WI 54915-1800
Phone: (920) 730-4411
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | 1272 | Wisconsin |
Profile Details
| NPI number | 1508850595 |
|---|---|
| LBN Legal business name | Green, Bernard L |
| Credentials | PH D |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 6th, 2005 |
| Last updated | Sep 2nd, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1508850595 | NPPES |
| Wisconsin | MEDICAID | 39042200 |
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