Provider Demographics
NPI:1467790212
Name:GREENBERG, ANDREW NATHANIEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:NATHANIEL
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-29
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00445900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical