Provider Demographics
NPI:1720950629
Name:GREEN DOT PUBLIC CORPERATION
Entity type:Organization
Organization Name:GREEN DOT PUBLIC CORPERATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SCHOOL MENTAL HEALTH SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:MAJA
Authorized Official - Middle Name:LEAH
Authorized Official - Last Name:STOBAUGH
Authorized Official - Suffix:
Authorized Official - Credentials:LPCC 11615
Authorized Official - Phone:775-813-0108
Mailing Address - Street 1:2030 OCEAN PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-4914
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:820 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-3408
Practice Address - Country:US
Practice Address - Phone:310-392-8751
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-19
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)