Provider Demographics
NPI:1588462766
Name:GREEN MARTIN, PRECIOUS TERESA MARIE
Entity type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:TERESA MARIE
Last Name:GREEN MARTIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1171 PORTER ST APT E
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-8173
Mailing Address - Country:US
Mailing Address - Phone:707-997-0005
Mailing Address - Fax:
Practice Address - Street 1:1171 PORTER ST APT E
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-8173
Practice Address - Country:US
Practice Address - Phone:707-997-0005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-04
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician