Provider Demographics
NPI:1992007710
Name:GINZBURG, MICHAEL SIMEN (MA)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:SIMEN
Last Name:GINZBURG
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3090 FITE CIR STE 102
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-1810
Mailing Address - Country:US
Mailing Address - Phone:916-549-3466
Mailing Address - Fax:
Practice Address - Street 1:3090 FITE CIR STE 102
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-1810
Practice Address - Country:US
Practice Address - Phone:916-549-3466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-30
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACO004912174400000X
CA113095106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No174400000XOther Service ProvidersSpecialist