Provider Demographics
NPI:1164528923
Name:BERGER-GREENSTEIN, JORI ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JORI
Middle Name:ANN
Last Name:BERGER-GREENSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:JORI
Other - Middle Name:ANN
Other - Last Name:BERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:720 HARRISON AVE
Mailing Address - Street 2:DOB 503
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2371
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BOSTON MEDICAL CTR PL
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-2908
Practice Address - Country:US
Practice Address - Phone:617-414-5546
Practice Address - Fax:617-414-6855
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7959103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110092134AMedicaid
MA110092134AMedicaid