Provider Demographics
NPI:1245396571
Name:GREENBERG, DEBRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBRA
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 1:4444 W RIVERSIDE DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4073
Mailing Address - Country:US
Mailing Address - Phone:818-566-3530
Mailing Address - Fax:818-845-1615
Practice Address - Street 1:4444 W RIVERSIDE DR
Practice Address - Street 2:SUITE 205
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4073
Practice Address - Country:US
Practice Address - Phone:818-566-3530
Practice Address - Fax:818-845-1615
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9641103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY9641OtherBLUE CROSS OF CALIFORNIA
GA680000015OtherRAILROAD MEDICARE
CAPSY096410Medicaid
CAPSY096410Medicaid
GA680000015OtherRAILROAD MEDICARE