Provider Demographics
NPI:1013012798
Name:GREENBAUM, IRIS (MSW)
Entity Type:Individual
Prefix:MS
First Name:IRIS
Middle Name:
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6041
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706
Mailing Address - Country:US
Mailing Address - Phone:510-704-7480
Mailing Address - Fax:510-704-7494
Practice Address - Street 1:2284 SHATTUCK AVE
Practice Address - Street 2:# 210 JFCS EB
Practice Address - City:BRKLY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-704-7480
Practice Address - Fax:510-704-7494
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW156161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical