Provider Demographics
NPI:1891979423
Name:GREENBERG, ROBERT CLIFFORD (MFT)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:CLIFFORD
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:CLIFFORD
Other - Last Name:GREENBERG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:865 3RD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95404-4518
Mailing Address - Country:US
Mailing Address - Phone:707-579-7928
Mailing Address - Fax:707-824-0911
Practice Address - Street 1:865 3RD ST STE 101
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-4518
Practice Address - Country:US
Practice Address - Phone:707-579-7928
Practice Address - Fax:707-824-0911
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 21447106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist