Provider Demographics
NPI:1114166568
Name:GREENBERG, MELANIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SHORELINE HWY
Mailing Address - Street 2:BUILDING B, SUITE 22
Mailing Address - City:MILL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94941-3639
Mailing Address - Country:US
Mailing Address - Phone:415-742-8062
Mailing Address - Fax:415-742-8062
Practice Address - Street 1:150 SHORELINE HWY
Practice Address - Street 2:BUILDING B, SUITE 22
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3639
Practice Address - Country:US
Practice Address - Phone:415-742-8062
Practice Address - Fax:415-742-8062
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22075103TB0200X, 103TC0700X, 103TH0004X, 103TP2701X
NY011964103TB0200X, 103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy