Provider Demographics
NPI:1447072111
Name:GREEN, BRENDA J (NBC-HWC)
Entity type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:J
Last Name:GREEN
Suffix:
Gender:F
Credentials:NBC-HWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:298 SUNSET KY
Mailing Address - Street 2:
Mailing Address - City:SECAUCUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07094-2213
Mailing Address - Country:US
Mailing Address - Phone:973-698-6251
Mailing Address - Fax:
Practice Address - Street 1:298 SUNSET KY
Practice Address - Street 2:
Practice Address - City:SECAUCUS
Practice Address - State:NJ
Practice Address - Zip Code:07094-2213
Practice Address - Country:US
Practice Address - Phone:973-698-6251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJA-3916852171400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach