Provider Demographics
NPI:1114071784
Name:STEINBERG, BRENDA MIRIAM (PHD)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:MIRIAM
Last Name:STEINBERG
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 1:63 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02140-2716
Mailing Address - Country:US
Mailing Address - Phone:617-354-1938
Mailing Address - Fax:
Practice Address - Street 1:63 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02140-2716
Practice Address - Country:US
Practice Address - Phone:617-354-1938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA441103TA0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW01558OtherBCBSPROVIDER NUMBER
MAW01558OtherBCBSPROVIDER NUMBER