Provider Demographics
NPI:1023738259
Name:DR. ERIC M GREENE, PSYCHOLOGIST INC.
Entity type:Organization
Organization Name:DR. ERIC M GREENE, PSYCHOLOGIST INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:310-571-8904
Mailing Address - Street 1:2600 W OLIVE AVE STE 570
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4549
Mailing Address - Country:US
Mailing Address - Phone:310-571-8904
Mailing Address - Fax:323-639-5169
Practice Address - Street 1:2600 W OLIVE AVE FL 5
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4572
Practice Address - Country:US
Practice Address - Phone:310-571-8904
Practice Address - Fax:323-639-5169
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-29
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty