Provider Demographics
NPI:1306028170
Name:GREENWOOD, VINCENT B (PHD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:B
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 501
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-1813
Mailing Address - Country:US
Mailing Address - Phone:202-244-0260
Mailing Address - Fax:202-244-3871
Practice Address - Street 1:5225 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 501
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-1813
Practice Address - Country:US
Practice Address - Phone:202-244-0260
Practice Address - Fax:202-244-3871
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1047103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC521266477Medicare PIN