Provider Demographics
NPI:1689698979
Name:GREENLEAF, ERIC (ERIC GREENLEAF, PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:
Last Name:GREENLEAF
Suffix:
Gender:M
Credentials:ERIC GREENLEAF, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1398 SOLANO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1832
Mailing Address - Country:US
Mailing Address - Phone:510-464-1140
Mailing Address - Fax:415-354-3286
Practice Address - Street 1:1398 SOLANO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1832
Practice Address - Country:US
Practice Address - Phone:510-464-1140
Practice Address - Fax:415-354-3286
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY3357103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY3357OtherSTATE LICENSE
CAPSY3357OtherSTATE LICENSE