Provider Demographics
NPI:1164575148
Name:GREENBERG, RONNIE JANE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:RONNIE
Middle Name:JANE
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:RONNIE
Other - Middle Name:
Other - Last Name:GREENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:211 W 56TH ST
Mailing Address - Street 2:17H
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4312
Mailing Address - Country:US
Mailing Address - Phone:224-747-9012
Mailing Address - Fax:212-247-2662
Practice Address - Street 1:211 W 56TH ST
Practice Address - Street 2:17H
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-4312
Practice Address - Country:US
Practice Address - Phone:224-747-9012
Practice Address - Fax:212-247-2662
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0317701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY142290OtherVALUE OPTIONS
NY7401092OtherGHI
NY9442OtherVBH
NYN75941Medicare ID - Type Unspecified