GREEN ROOM PSYCHOLOGY SERVICES INCORPORATION (NPI# 1811263957) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811263957 |
| Entity Type | Organization |
| Organization Name | GREEN ROOM PSYCHOLOGY SERVICES INCORPORATION |
| Practice Address |
5252 Balboa Ave Suite 204 San Diego CA 92117-6906 |
| Practice Telephone | 8584809118 |
| Practice Fax Number | 8587129035 |
| Mailing Telephone | 8584809118 |
| Mailing Fax Number | 8587129035 |
| Enumeration Date | 2012-03-22 |
| Last Update Date | 2017-03-24 |
| Authorized Official Name | DR. NEDA KHODAPARAST (CEO) |
| Authorized Official Telephone | 8584809118 |
| Authorized Official Credential | PSYD, QME |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 23114 | CA | Other Service Providers |
| Street Address |
5252 BALBOA AVE SUITE 204 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92117-6906 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205838448 | Howard Jay Waldman | Physical Medicine & Rehabilitation | 5252 Balboa Ave, Ste 901, San Diego, CA 92117-6906 | 2005-06-01 |
| 1497291868 | Nancy Jean Wahlig | Social Worker | 5252 Balboa Ave, #803, San Diego, CA 92117-6906 | 2017-01-10 |
| 1659827772 | Nicholas Sean O'connor | Chiropractor | 5252 Balboa Ave, Suite 701, San Diego, CA 92117-6906 | 2016-08-29 |
| 1407309669 | Susanna Moneva | Marriage & Family Therapist | 5252 Balboa Ave, 709, San Diego, CA 92117-6906 | 2016-07-24 |
| 1205287620 | Zara Jeffrey | Massage Therapist | 5252 Balboa Ave, Suite 701, San Diego, CA 92117-6906 | 2016-06-27 |
| 1609236314 | Jeffry S Hays Dc A Chiropractic Corporation | Chiropractor | 5252 Balboa Ave, Suite 1002, San Diego, CA 92117-6906 | 2016-02-24 |
| 1891169025 | Julie Kraft | Marriage & Family Therapist | 5252 Balboa Ave, Suite 707, San Diego, CA 92117-6906 | 2015-11-27 |
| 1629474929 | Pathway 2 Healing, Inc. | Counselor | 5252 Balboa Ave, Suite 803, San Diego, CA 92117-6906 | 2014-11-13 |
| 1083010789 | Victor Bloomberg | Social Worker | 5252 Balboa Ave, Ste 803, San Diego, CA 92117-6906 | 2014-11-07 |
| 1922420678 | Abigail Rosenthal Burd | Social Worker | 5252 Balboa Ave, Suite 803, San Diego, CA 92117-6906 | 2014-01-15 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154956050 | Enbara Corporation | Dentist | 5189 Clairmont Mesa Blvd, San Diego, CA 92117 | 2020-03-11 |
| 1568956050 | Lourdes C Villagran | Case Manager/Care Coordinator | 4474 Charger Blvd, San Diego, CA 92117 | 2018-06-18 |
| 1750893509 | Dzendzel Family Chiropractic | Chiropractor | 3650 Clairemont Drive, Ste 2, San Diego, CA 92117 | 2017-11-02 |
| 1205355401 | Alan Ford | Counselor | 4150 Ute Dr., San Diego, CA 92117 | 2017-09-19 |
| 1780101238 | Allison Dawn Heeney | Occupational Therapist | 3386 Hopi Place, San Diego, CA 92117 | 2017-08-25 |
| 1275074379 | Rachel Gabrielle Packer | Counselor | 5252 Balboa Ave Ste 801, San Diego, CA 92117 | 2017-03-09 |
| 1316482995 | Lisa Graff-marsh, Inc. | Social Worker | 4985 Park Rim Dr., San Diego, CA 92117 | 2017-01-05 |
| 1417408949 | Markos and Markos 1 Inc | Private Vehicle | 4495 Clairemont Mesa Blvd, San Diego, CA 92117 | 2016-10-19 |
| 1801341813 | Huynh and Habashi Dental Corporation | Dentist | 2995 Clairemont Dr, Suite A, San Diego, CA 92117 | 2016-08-19 |
| 1184076077 | Tammy Monck | Optometrist | 3952 Clairemont Mesa Blvd Ste I, San Diego, CA 92117 | 2016-07-05 |
| Find all providers in zip 92117 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1114541463 | Serena Mink | Specialist | 100 Park Plz Apt 407, San Diego, CA 92101-6710 | 2020-06-02 |
| 1023648201 | Pamela Renea Crane | Specialist | 3237 Meade Ave, San Diego, CA 92116-4519 | 2020-01-16 |
| 1184199853 | Oliver Rakeem Taylor | Specialist | 1265 Angelus Ave, San Diego, CA 92114-3108 | 2018-10-09 |
| 1376040923 | Mark Edmond Rierson | Specialist | 2333 1st Ave Ste 106, San Diego, CA 92101-1538 | 2018-04-10 |
| 1790232635 | Cristina Zheng-castruita | Specialist | 9308 Babauta Rd, Apt. 62, San Diego, CA 92129-4922 | 2016-09-08 |
| 1689027955 | Neelam Agashe | Specialist | 3445 Lebon Dr Apt 1215, San Diego, CA 92122-5267 | 2016-07-21 |
| 1376998864 | Briniti Ichull | Specialist | 3941 Kurtz St, San Diego, CA 92110 | 2016-05-03 |
| 1952765935 | Jacqueline Morgan | Specialist | 9625 Black Mountain Rd Ste 300, San Diego, CA 92126-4598 | 2016-04-06 |
| 1710341862 | Comprehensive Medical Reporting Services | Specialist | 9040 Friars Rd., Ste. 410, San Diego, CA 92108 | 2016-04-05 |
| 1790150555 | Mahmood Nazari | Specialist | 6209 Lake Apopka Pl, 6209 Lake Apopka Place, San Diego, CA 92119-3520 | 2015-12-04 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.