Provider Demographics
NPI:1235601873
Name:GREENBERG, STACY TARA (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:STACY
Middle Name:TARA
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 OAK ST STE 104
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:NY
Mailing Address - Zip Code:11530-6554
Mailing Address - Country:US
Mailing Address - Phone:516-485-5976
Mailing Address - Fax:
Practice Address - Street 1:400 OAK ST STE 104
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:NY
Practice Address - Zip Code:11530-6554
Practice Address - Country:US
Practice Address - Phone:516-485-5976
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-20
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008289101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health