Provider Demographics
NPI:1417151523
Name:GREENBERG, MARK STEVEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEVEN
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:82 MARLBOROUGH ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02116-2020
Mailing Address - Country:US
Mailing Address - Phone:617-262-7379
Mailing Address - Fax:617-558-1079
Practice Address - Street 1:82 MARLBOROUGH ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02116-2020
Practice Address - Country:US
Practice Address - Phone:617-262-7379
Practice Address - Fax:617-558-1079
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3411103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist