Provider Demographics
NPI:1235209016
Name:GREENWALD, CAMILLE JANICKI (PHD)
Entity Type:Individual
Prefix:DR
First Name:CAMILLE
Middle Name:JANICKI
Last Name:GREENWALD
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 1:380 N OLD WOODWARD
Mailing Address - Street 2:STE 156
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5347
Mailing Address - Country:US
Mailing Address - Phone:248-594-8206
Mailing Address - Fax:248-594-7663
Practice Address - Street 1:380 N OLD WOODWARD
Practice Address - Street 2:STE 156
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-5347
Practice Address - Country:US
Practice Address - Phone:248-594-8206
Practice Address - Fax:248-594-7663
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIBCBSM0F33711OtherBCBS