Provider Demographics
NPI:1215034970
Name:GREENBERG, LISA R (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:R
Last Name:GREENBERG
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 1:2 WILSON LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-2509
Mailing Address - Country:US
Mailing Address - Phone:973-765-0313
Mailing Address - Fax:973-765-0313
Practice Address - Street 1:2 WILSON LN
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:NJ
Practice Address - Zip Code:07940-2509
Practice Address - Country:US
Practice Address - Phone:973-765-0313
Practice Address - Fax:973-765-0313
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2011-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00198600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
623463Medicare ID - Type Unspecified
623463Medicare UPIN