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General NPI Number Information
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NPI Number | 1194229914
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Entity Type | Individual
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Provider Name | MICHAEL JOEL GREENBERG PHD
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Gender | Male
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Dates
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Enumeration Date | 03/19/2018
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Last Update Date | 05/20/2020
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Provider Practice Location Address
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Address Line | 1060 S SHERBOURNE DR APT 308
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City | LOS ANGELES
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State | CA
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Zip | 90035-2145
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Country | US
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Telephone | 347-752-0594
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Fax |
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Provider Business Mailing Address
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Address Line | 1060 S SHERBOURNE DR APT 308
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City | LOS ANGELES
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State | CA
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Zip | 90035-2145
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Country | US
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Telephone | 347-752-0594
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 022587-1
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number | 022587-1
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number | 022587-1
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 022587-1
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License Number State | NY
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Taxonomy #5
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 022587-1
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License Number State | NY
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