Provider Demographics
NPI:1558484204
Name:STANFORD, GREG S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:S
Last Name:STANFORD
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 1:150 N SANTA ANITA AVE STE 735
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3145
Mailing Address - Country:US
Mailing Address - Phone:626-415-4452
Mailing Address - Fax:
Practice Address - Street 1:150 N SANTA ANITA AVE STE 735
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3145
Practice Address - Country:US
Practice Address - Phone:626-415-4452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-09
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical