Provider Demographics
NPI:1225598915
Name:GREENBERGER, ROBERT (LCSW)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GREENBERGER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 FOOTHILL LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2348
Mailing Address - Country:US
Mailing Address - Phone:631-766-1210
Mailing Address - Fax:
Practice Address - Street 1:445 BROADHOLLOW RD STE 25
Practice Address - Street 2:
Practice Address - City:MELVILLE
Practice Address - State:NY
Practice Address - Zip Code:11747-3645
Practice Address - Country:US
Practice Address - Phone:516-873-8056
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-20
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073261-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical