Healthcare Provider Details

I. General information

NPI: 1215343595
Provider Name (Legal Business Name): PETER GLEIBERMAN JR. PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 06/17/2022
Certification Date: 06/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 S PACIFIC COAST HWY STE F
REDONDO BEACH CA
90277-4987
US

IV. Provider business mailing address

1200 S PACIFIC COAST HWY STE F
REDONDO BEACH CA
90277-4987
US

V. Phone/Fax

Practice location:
  • Phone: 424-391-3585
  • Fax:
Mailing address:
  • Phone: 424-262-9445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY33347
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: