Provider Demographics
NPI:1043011448
Name:GREEN, ZAJAH GLORIANA
Entity type:Individual
Prefix:MS
First Name:ZAJAH
Middle Name:GLORIANA
Last Name:GREEN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2113 SW 173RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5522
Mailing Address - Country:US
Mailing Address - Phone:786-720-6754
Mailing Address - Fax:
Practice Address - Street 1:2000 NW 150TH AVE STE 2112
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-2870
Practice Address - Country:US
Practice Address - Phone:754-264-8779
Practice Address - Fax:754-264-8308
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician