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General NPI Number Information
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NPI Number | 1861841645
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Entity Type | Organization
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Legal Business Name | MARNI GREENBERG, PSY.D. CLINICAL PSYCHOLOGIST PC
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Dates
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Enumeration Date | 06/12/2016
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Last Update Date | 06/12/2016
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Provider Practice Location Address
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Address Line | 3990 OLD TOWN AVE STE A208
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City | SAN DIEGO
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State | CA
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Zip | 92110-2967
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Country | US
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Telephone | 858-432-3290
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Fax | 619-228-9503
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Provider Business Mailing Address
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Address Line | 3990 OLD TOWN AVE STE A208
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City | SAN DIEGO
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State | CA
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Zip | 92110-2967
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Country | US
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Telephone | 858-432-3290
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Fax | 619-228-9503
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Authorized Official
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Title or Position | OWNER
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Name | MARNI GREENBERG
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Credential | PSY.D.
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Telephone | 858-432-3290
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY23970
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License Number State | CA
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