Healthcare Provider Details

I. General information

NPI: 1114567310
Provider Name (Legal Business Name): ERIC M. GREENE PH D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 W OLIVE AVE STE 570
BURBANK CA
91505-4549
US

IV. Provider business mailing address

2600 W OLIVE AVE STE 570
BURBANK CA
91505-4549
US

V. Phone/Fax

Practice location:
  • Phone: 310-571-8904
  • Fax: 323-639-5169
Mailing address:
  • Phone: 323-577-5898
  • Fax: 323-639-5169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY31555
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TP0814X
TaxonomyPsychoanalysis Psychologist
License NumberPSY31555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: