Provider Demographics
NPI:1184634529
Name:GREENBERG, DAVID BARRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:BARRY
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 E GENESEE ST
Mailing Address - Street 2:STE C4
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-1129
Mailing Address - Country:US
Mailing Address - Phone:315-446-1562
Mailing Address - Fax:
Practice Address - Street 1:100 WOODBERRY LN
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-1746
Practice Address - Country:US
Practice Address - Phone:315-445-5554
Practice Address - Fax:315-446-1562
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5621103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY40030BMedicare ID - Type UnspecifiedPSYCHOLOGIST