Provider Demographics
NPI:1023005584
Name:GREENBERG, RUTH L (PHD)
Entity Type:Individual
Prefix:
First Name:RUTH
Middle Name:L
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 1:1528 WALNUT ST
Mailing Address - Street 2:SUITE 1203
Mailing Address - City:PHILA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-3604
Mailing Address - Country:US
Mailing Address - Phone:215-546-8530
Mailing Address - Fax:
Practice Address - Street 1:1528 WALNUT ST
Practice Address - Street 2:SUITE 1203
Practice Address - City:PHILA
Practice Address - State:PA
Practice Address - Zip Code:19102-3604
Practice Address - Country:US
Practice Address - Phone:215-546-8530
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004037L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGR621668Medicare ID - Type UnspecifiedHGSA IDENTIFIER