Provider Demographics
NPI:1770244154
Name:GREENBERG, BONNIE LYNN (JD, MFT)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:LYNN
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:JD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:418 N GREENCRAIG RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2840
Mailing Address - Country:US
Mailing Address - Phone:310-562-0666
Mailing Address - Fax:
Practice Address - Street 1:418 N GREENCRAIG RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-2840
Practice Address - Country:US
Practice Address - Phone:310-562-0666
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1000065106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist