Provider Demographics
NPI:1437618881
Name:ANDREW GREENBERG PSYD CLINICAL PSYCHOLOGIST LLC
Entity Type:Organization
Organization Name:ANDREW GREENBERG PSYD CLINICAL PSYCHOLOGIST LLC
Other - Org Name:LIVING WELL PSYCHOLOGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:N
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:862-812-0441
Mailing Address - Street 1:35 CODDINGTON TER
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-3633
Mailing Address - Country:US
Mailing Address - Phone:862-812-0441
Mailing Address - Fax:
Practice Address - Street 1:35 CODDINGTON TER
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039-3633
Practice Address - Country:US
Practice Address - Phone:862-812-0441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-15
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty