Provider Demographics
NPI:1104358696
Name:GREENBAUM, CHLOE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHLOE
Middle Name:
Last Name:GREENBAUM
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 1:872 MASSACHUSETTS AVENUE
Mailing Address - Street 2:SUITE 2-1
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-2316
Mailing Address - Country:US
Mailing Address - Phone:617-807-0773
Mailing Address - Fax:
Practice Address - Street 1:872 MASSACHUSETTS AVENUE
Practice Address - Street 2:SUITE 2-1
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-2316
Practice Address - Country:US
Practice Address - Phone:617-807-0773
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-03
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11089103TH0100X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program