Basic Information
| Provider Information | |||||||||
| NPI: | 1770688699 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GREENBERG | ||||||||
| FirstName: | DIANE | ||||||||
| MiddleName: | MARLA | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 220 18TH AVE E | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981125231 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1660 S COLUMBIAN WAY | ||||||||
| Address2: | S-123-PCC | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981081532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2067642965 | ||||||||
| FaxNumber: | 2067642936 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2006 | ||||||||
| LastUpdateDate: | 02/23/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103T00000X | 1519 | WA | N | Behavioral Health & Social Service Providers | Psychologist | 103TC0700X | 1519 | WA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TF0000X | 1519 | WA | N | Behavioral Health & Social Service Providers | Psychologist | Family | 103TH0100X | 1519 | WA | N | Behavioral Health & Social Service Providers | Psychologist | Health Service | 103TP2701X | 1519 | WA | N | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
No ID Information.