Provider Demographics
NPI:1508843863
Name:GREENBAUM, IRIS (LCSW)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 N BROAD ST
Mailing Address - Street 2:P.O. BOX 581
Mailing Address - City:GRIFFITH
Mailing Address - State:IN
Mailing Address - Zip Code:46319-2220
Mailing Address - Country:US
Mailing Address - Phone:219-934-1900
Mailing Address - Fax:219-934-1900
Practice Address - Street 1:223 N BROAD ST
Practice Address - Street 2:
Practice Address - City:GRIFFITH
Practice Address - State:IN
Practice Address - Zip Code:46319-2220
Practice Address - Country:US
Practice Address - Phone:219-934-1900
Practice Address - Fax:219-934-1900
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004787A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN217050Medicare ID - Type Unspecified