Active NPI
Glenn Robert Lundberg, PSYD
- Clinical Psychologist
- Stockton, CA
National Provider Identifier
1689162182
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 30068
- Practice address
- 7707 Austin Rd
Stockton, CA 95215-8312 - Phone
- (209) 467-6954
- NPI assigned
- Apr 30, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 30068 | CA | Primary |
Addresses
Primary practice location
7707 Austin Rd
Stockton, CA 95215-8312
Mailing address
1436 Indian Valley Rd
Novato, CA 94947-4310
Phone (415) 328-6300
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30068 | CA | MD | Pharmacy Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525046400000",
"number": "1689162182",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1436 INDIAN VALLEY RD",
"city": "NOVATO",
"state": "CA",
"postal_code": "949474310",
"telephone_number": "415-328-6300"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7707 AUSTIN RD",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952158312",
"telephone_number": "209-467-6954"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUNDBERG",
"first_name": "GLENN",
"middle_name": "ROBERT",
"name_prefix": "Dr.",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-30",
"last_updated": "2018-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "30068",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.