Provider Demographics
NPI:1750456091
Name:GREENFIELD, ELLEN MARGOT (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:MARGOT
Last Name:GREENFIELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9663 TIERRA GRANDE ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-4568
Mailing Address - Country:US
Mailing Address - Phone:619-840-5045
Mailing Address - Fax:858-689-6979
Practice Address - Street 1:9663 TIERRA GRANDE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4568
Practice Address - Country:US
Practice Address - Phone:619-840-5045
Practice Address - Fax:858-689-6979
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15279103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY015279Medicare ID - Type UnspecifiedMEDI-CAL