Provider Demographics
NPI:1588859011
Name:GREENBERG, EDWIN MARK (PSYCHOLOGIST)
Entity Type:Individual
Prefix:DR
First Name:EDWIN
Middle Name:MARK
Last Name:GREENBERG
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Gender:M
Credentials:PSYCHOLOGIST
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Mailing Address - Street 1:1245 16TH ST
Mailing Address - Street 2:STE 210
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1235
Mailing Address - Country:US
Mailing Address - Phone:310-828-1134
Mailing Address - Fax:310-454-0502
Practice Address - Street 1:1245 16TH ST
Practice Address - Street 2:STE 210
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1235
Practice Address - Country:US
Practice Address - Phone:310-828-1134
Practice Address - Fax:310-454-0502
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2024-03-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY4816103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist