Provider Demographics
NPI:1235613514
Name:GREENBERG, MAXIMANOVA O'REILLY (AACR)
Entity Type:Individual
Prefix:
First Name:MAXIMANOVA
Middle Name:O'REILLY
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:AACR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10700 MERIDIAN AVE N STE G11
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-9008
Mailing Address - Country:US
Mailing Address - Phone:206-361-3020
Mailing Address - Fax:
Practice Address - Street 1:10700 MERIDIAN AVE N STE G11
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98133-9008
Practice Address - Country:US
Practice Address - Phone:206-461-4544
Practice Address - Fax:206-461-6939
Is Sole Proprietor?:No
Enumeration Date:2018-09-21
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG60707090104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker