Healthcare Provider Details

I. General information

NPI: 1023491180
Provider Name (Legal Business Name): LAUREN MIRIAM GREENBERG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2015
Last Update Date: 03/25/2020
Certification Date: 03/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 MIRANDA AVE # 116B
PALO ALTO CA
94304-1207
US

IV. Provider business mailing address

701 BENSON ST
PHILADELPHIA PA
19111-1932
US

V. Phone/Fax

Practice location:
  • Phone: 650-849-1992
  • Fax:
Mailing address:
  • Phone: 215-828-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPS018296
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS018296
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: