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General NPI Number Information
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NPI Number | 1770688699
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Entity Type | Individual
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Provider Name | DIANE MARLA GREENBERG PH.D.
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Gender | Female
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 02/23/2015
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Provider Practice Location Address
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Address Line | 1660 S COLUMBIAN WAY S-123-PCC
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City | SEATTLE
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State | WA
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Zip | 98108-1532
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Country | US
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Telephone | 206-764-2965
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Fax | 206-764-2936
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Provider Business Mailing Address
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Address Line | 220 18TH AVE E
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City | SEATTLE
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State | WA
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Zip | 98112-5231
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Country | US
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Telephone |
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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 | 1519
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1519
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | 1519
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License Number State | WA
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Taxonomy #4
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Taxonomy Code | 103TH0100X
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Taxonomy Name | Health Service Psychologist
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License Number | 1519
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License Number State | WA
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Taxonomy #5
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number | 1519
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License Number State | WA
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