Provider Demographics
NPI:1861841645
Name:MARNI GREENBERG, PSY.D. CLINICAL PSYCHOLOGIST PC
Entity Type:Organization
Organization Name:MARNI GREENBERG, PSY.D. CLINICAL PSYCHOLOGIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARNI
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:858-432-3290
Mailing Address - Street 1:3990 OLD TOWN AVE STE A208
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-2967
Mailing Address - Country:US
Mailing Address - Phone:858-432-3290
Mailing Address - Fax:619-228-9503
Practice Address - Street 1:3990 OLD TOWN AVE STE A208
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-2967
Practice Address - Country:US
Practice Address - Phone:858-432-3290
Practice Address - Fax:619-228-9503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-12
Last Update Date:2016-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23970103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty