Provider Demographics
NPI:1033204839
Name:GREENWOOD, NATHANIAL S (LCSW)
Entity Type:Individual
Prefix:
First Name:NATHANIAL
Middle Name:S
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:LCSW
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 10414
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33773-0414
Mailing Address - Country:US
Mailing Address - Phone:800-632-6074
Mailing Address - Fax:
Practice Address - Street 1:3125 POPLARWOOD CT
Practice Address - Street 2:THE ASPEN BLDG STE 100
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27604-1084
Practice Address - Country:US
Practice Address - Phone:800-632-6074
Practice Address - Fax:866-341-7509
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0007001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6003257Medicaid
NC2877884Medicare ID - Type UnspecifiedMEDICARE # - PARADIGM