Healthcare Provider Details

I. General information

NPI: 1023738259
Provider Name (Legal Business Name): DR. ERIC M GREENE, PSYCHOLOGIST INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
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 Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. ERIC M GREENE
Title or Position: CEO
Credential: PH D
Phone: 323-577-5898