Healthcare Provider Details

I. General information

NPI: 1710802889
Provider Name (Legal Business Name): STARR GREENSKY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7550 CANTON DR
LEMON GROVE CA
91945-4021
US

IV. Provider business mailing address

6555 AMBROSIA DR APT 1312
SAN DIEGO CA
92124-3233
US

V. Phone/Fax

Practice location:
  • Phone: 619-825-5633
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: