Provider Demographics
NPI:1427180017
Name:GREENBERG, MARILYN (MA,CCC)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:MA,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BLUE DEVIL LN
Mailing Address - Street 2:
Mailing Address - City:MERCERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08619-1103
Mailing Address - Country:US
Mailing Address - Phone:609-586-5959
Mailing Address - Fax:609-586-5959
Practice Address - Street 1:9 BLUE DEVIL LN
Practice Address - Street 2:
Practice Address - City:MERCERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08619-1103
Practice Address - Country:US
Practice Address - Phone:609-586-5959
Practice Address - Fax:609-586-5959
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00019700235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist