Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 022587-1 | NY |
N | 103T00000X | Psychologist | 022587-1 | NY |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 022587-1 | NY |
Y | 103G00000X | Clinical Psychologist | 022587-1 | NY |
Y | 103TC0700X | Clinical Psychologist | 022587-1 | NY |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 022587-1 | NY |
N | 103TF0000X | Family Psychologist | 022587-1 | NY |
NPI | 1194229914 |
---|---|
Provider Name | Dr. Michael Joel Greenberg |
First Address | Los Angeles, CA 90035-2145 |
Second Address | Los Angeles, CA 90035-2145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2018 |
Last Update Date | 20/05/2020 |