Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY18686 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY18686 | CA |
NPI | 1013154301 |
---|---|
Provider Name | Ivan West Greenspan |
First Address | Tarzana, CA 91356-1162 |
Second Address | Sherman Oaks, CA 91403-2110 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2009 |
Last Update Date | 08/01/2009 |