Provider Demographics
NPI:1376167882
Name:CHLOE GREENBAUM, PH.D., P.C.
Entity Type:Organization
Organization Name:CHLOE GREENBAUM, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHLOE
Authorized Official - Middle Name:ALEXA
Authorized Official - Last Name:GREENBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:617-807-0773
Mailing Address - Street 1:872 MASSACHUSETTS AVENUE
Mailing Address - Street 2:SUITE 2-1
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139
Mailing Address - Country:US
Mailing Address - Phone:914-420-7166
Mailing Address - Fax:
Practice Address - Street 1:872 MASSACHUSETTS AVENUE
Practice Address - Street 2:SUITE 2-1
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139
Practice Address - Country:US
Practice Address - Phone:617-807-0773
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-31
Last Update Date:2020-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1104358696OtherNPI ENTITY TYPE I