Provider Demographics
NPI:1346770062
Name:DONNELLY-GREENBERG, JENNIFER ERIN (PHD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ERIN
Last Name:DONNELLY-GREENBERG
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 1:5507 NESCONSET HWY STE 215
Mailing Address - Street 2:
Mailing Address - City:MOUNT SINAI
Mailing Address - State:NY
Mailing Address - Zip Code:11766-2031
Mailing Address - Country:US
Mailing Address - Phone:908-656-0713
Mailing Address - Fax:
Practice Address - Street 1:1000 MAIN ST STE G
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2250
Practice Address - Country:US
Practice Address - Phone:631-256-7753
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2024-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021860103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical