Provider Demographics
NPI:1235280686
Name:B. RONNI GREENBERG, PSY.D., PC
Entity Type:Organization
Organization Name:B. RONNI GREENBERG, PSY.D., PC
Other - Org Name:RONNI GREENBERG, PSY.,D.
Other - Org Type:Other Name
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:773-405-6007
Mailing Address - Street 1:3748 N ASHLAND AVE
Mailing Address - Street 2:UNIT 1-N
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-6098
Mailing Address - Country:US
Mailing Address - Phone:773-405-6007
Mailing Address - Fax:
Practice Address - Street 1:3748 N ASHLAND AVE
Practice Address - Street 2:UNIT 1-N
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-6098
Practice Address - Country:US
Practice Address - Phone:773-405-6007
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-14
Last Update Date:2022-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005250103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21623217OtherBLUE CROSS BLUE SHIELD
IL207311OtherVALUE OPTIONS
IL7999116OtherAETNA