Provider Demographics
NPI:1255549168
Name:GREENWOOD, ANDERS C (PSYD, PHD)
Entity type:Individual
Prefix:DR
First Name:ANDERS
Middle Name:C
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:PSYD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32036 PALOMA COURT
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-4078
Mailing Address - Country:US
Mailing Address - Phone:510-364-4825
Mailing Address - Fax:510-475-5905
Practice Address - Street 1:703 MARKET ST
Practice Address - Street 2:SUITE 410
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2102
Practice Address - Country:US
Practice Address - Phone:510-364-4825
Practice Address - Fax:510-475-5905
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X
CAPSY22009103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAW483Medicare PIN