Provider Demographics
NPI:1487857397
Name:SCHWARZ, GREG STUART (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:STUART
Last Name:SCHWARZ
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18034 VENTURA BLVD # 455
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3516
Mailing Address - Country:US
Mailing Address - Phone:310-773-8200
Mailing Address - Fax:818-347-9688
Practice Address - Street 1:5535 BALBOA BLVD
Practice Address - Street 2:STE. 217
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1516
Practice Address - Country:US
Practice Address - Phone:310-773-8200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2009-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22808103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACA029AMedicare PIN