Provider Demographics
NPI:1881705887
Name:GREENBERG, CHIWAMI (PSYD)
Entity type:Individual
Prefix:DR
First Name:CHIWAMI
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RIVAGE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT COAST
Mailing Address - State:CA
Mailing Address - Zip Code:92657-0100
Mailing Address - Country:US
Mailing Address - Phone:949-760-5402
Mailing Address - Fax:
Practice Address - Street 1:4425 JAMBOREE RD
Practice Address - Street 2:STE 173
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3010
Practice Address - Country:US
Practice Address - Phone:714-357-5110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17092103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist