Provider Demographics
NPI:1023180486
Name:GREENBERG, LEONARD DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:DAVID
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 WILDWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02476-6224
Mailing Address - Country:US
Mailing Address - Phone:781-641-2210
Mailing Address - Fax:781-648-4717
Practice Address - Street 1:76 BEDFORD STREET
Practice Address - Street 2:SUITE 21
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4641
Practice Address - Country:US
Practice Address - Phone:781-861-6662
Practice Address - Fax:781-648-4717
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3139103TC0700X, 103TF0000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1853040Medicaid
329375OtherHARVARD PILGRIM
016568OtherVALUE OPTIONS
MA760699OtherTUFTS
108146OtherMAGELLAN
MA1899368OtherMBHP
016568OtherVALUE OPTIONS
MA1853040Medicaid