Provider Demographics
NPI:1114450996
Name:GREENBERG, ANN D (LIC ACC CMHC)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:D
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:LIC ACC CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 ELM ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850
Mailing Address - Country:US
Mailing Address - Phone:607-272-7792
Mailing Address - Fax:607-272-7792
Practice Address - Street 1:408 ELM ST
Practice Address - Street 2:405 TAUGHANOOK BLVD.
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850
Practice Address - Country:US
Practice Address - Phone:607-272-7792
Practice Address - Fax:607-272-7792
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101Y00000X, 101YM0800X
NY000759171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171100000XOther Service ProvidersAcupuncturist