Provider Demographics
NPI:1639458482
Name:GREG SCHWARZ, PSY.D., AND ASSOCIATES, A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:GREG SCHWARZ, PSY.D., AND ASSOCIATES, A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PRESIDENT AND CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GREG
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:SCHWARZ
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:310-773-8200
Mailing Address - Street 1:18034 VENTURA BLVD
Mailing Address - Street 2:#455
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:310-943-0434
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:310-943-0434
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-10
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22808103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty