| Greenberg/gordon, Ph.ds., Psychologists, A Professional Corporation | |
|
1245 16th St Ste 210 Santa Monica CA 90404-1240 | |
| (310) 828-1134 | |
| (310) 454-0502 |
| Full Name | Greenberg/gordon, Ph.ds., Psychologists, A Professional Corporation |
|---|---|
| Speciality | Psychologist |
| Location | 1245 16th St Ste 210, Santa Monica, California |
| Authorized Official Name and Position | Edwin Mark Greenberg (PRESIDENT) |
| Authorized Official Contact | 3108281134 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Greenberg/gordon, Ph.ds., Psychologists, A Professional Corporation 455 W Rustic Rd Santa Monica CA 90402-1113 Ph: (310) 828-1134 | Greenberg/gordon, Ph.ds., Psychologists, A Professional Corporation 1245 16th St Ste 210 Santa Monica CA 90404-1240 Ph: (310) 828-1134 |
| NPI Number | 1780602664 |
|---|---|
| Provider Enumeration Date | 07/18/2006 |
| Last Update Date | 12/18/2012 |
| Medicare PECOS PAC ID | 8921050428 |
|---|---|
| Medicare Enrollment ID | O20050212000035 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780602664 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Edwin M Greenberg |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1588859011 PECOS PAC ID: 3375595879 Enrollment ID: I20050215000435 |
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