Provider Demographics
NPI:1548584287
Name:GREENBERG, MARTIN RICHARD
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:RICHARD
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 FULLERTON CT STE 202
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-6204
Mailing Address - Country:US
Mailing Address - Phone:916-922-3882
Mailing Address - Fax:916-922-0286
Practice Address - Street 1:10 FULLERTON CT STE 202
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-6204
Practice Address - Country:US
Practice Address - Phone:916-922-3882
Practice Address - Fax:916-922-0286
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-24
Last Update Date:2010-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASY12330103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist