Provider Demographics
NPI:1144410804
Name:GREENBERG, LISA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
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 1:5627 CABOT DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2247
Mailing Address - Country:US
Mailing Address - Phone:510-594-1926
Mailing Address - Fax:510-594-1673
Practice Address - Street 1:5627 CABOT DR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2247
Practice Address - Country:US
Practice Address - Phone:510-594-1926
Practice Address - Fax:510-594-1673
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2015-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CAPSY 24788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor