MEDICARE: DANIEL GREENWALD PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program
2	103T00000X	Psychologist	PSY35740	CA

General Provider Information

NPI Number	:	1598274391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL GREENWALD PSYD

Provider Business Mailing Address
First Line	:	22157 CLARENDON ST UNIT 4
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6308
Country	:	US
Telephone Number	:	818-224-0788
Fax Number	:

Provider Business Practice Location Address
First Line	:	22157 CLARENDON ST UNIT 4
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91367-6308
Country	:	US
Telephone Number	:	818-224-0788
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2017
Last Update Date	:	07/14/2025

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