EBONY GREEN
NPI 1710729801
Peer Specialist in Oakland, CA

Q: What is the provider's specialty?

The provider's specialty is Peer Specialist with taxonomy code 175T00000X.

Active since June 10, 2024

3800 COOLIDGE AVE, OAKLAND, CA 94602(510) 482-2244 Get Directions Write a Review

NPPES record last updated: June 23, 2025. Verified against the NPPES registry weekly; last sync: July 19, 2026.

Record update history: Jun 23, 2025, Nov 12, 2024, Jun 10, 2024 (3 updates tracked since 2024).

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About Ebony Green NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EBONY GREEN (NPI 1710729801) is an individual peer specialist in Oakland, California, licensed in California (MPSS-DEGOQU) and active in the NPI registry since June 2024.

NPPES Registry Identity

NPI1710729801

Entity TypeIndividualFemale

Primary Taxonomy175T00000X

Provider Legal NameEBONY GREEN

Location Address3800 COOLIDGE AVEOakland, CA 94602-3311

Mailing Address4712 Foothill BlvdOakland, CA 94601-5350 · (603) 339-6632

Phone(510) 482-2244

Sole ProprietorNo

Enumeration DateJune 10, 2024

Last NPPES UpdateJune 23, 20253 updates tracked since enumeration

NPPES CertifiedJune 23, 2025

✔ NPI 1710729801 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

★ Primary SpecialtyPeer SpecialistOther Service Providers

Taxonomy Code175T00000X

License✔ Licensed in CA · MPSS-DEGOQU

Definition

Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority.

Also ListedCase Manager/Care CoordinatorTaxonomy 171M00000X

Also ListedCommunity Health WorkerTaxonomy 172V00000X

3800 COOLIDGE AVE, Oakland, CA 94602

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