Provider Demographics
NPI:1114166568
Name:GREENBERG, MELANIE (PHD)
Entity type:Individual
Prefix:DR
First Name:MELANIE
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8500 OLD STONEFIELD CHASE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-6150
Mailing Address - Country:US
Mailing Address - Phone:415-742-8062
Mailing Address - Fax:415-742-8062
Practice Address - Street 1:12625 HIGH BLUFF DR STE 111
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2053
Practice Address - Country:US
Practice Address - Phone:415-742-8062
Practice Address - Fax:415-742-8062
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22075103T00000X, 103TH0004X, 103TC0700X, 103TH0004X, 103TP2701X
NY011964103TC0700X, 103TH0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy