Provider Demographics
NPI:1619993557
Name:GREENBERG, TAMARA MCCLINTOCK (PSYD, MS)
Entity Type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:MCCLINTOCK
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:PSYD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2538 CALIFORNIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2616
Mailing Address - Country:US
Mailing Address - Phone:415-775-7220
Mailing Address - Fax:415-929-8771
Practice Address - Street 1:2538 CALIFORNIA ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2616
Practice Address - Country:US
Practice Address - Phone:415-775-7220
Practice Address - Fax:415-929-8771
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16206103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY16206Medicare ID - Type Unspecified