Provider Demographics
NPI:1518298546
Name:GREENBAUM, GAIL RENEE (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:GAIL
Middle Name:RENEE
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 1:100 CENTER GROVE RD
Mailing Address - Street 2:APT. 12-7
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4452
Mailing Address - Country:US
Mailing Address - Phone:973-525-5461
Mailing Address - Fax:862-397-4603
Practice Address - Street 1:20 ELM ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07960-8804
Practice Address - Country:US
Practice Address - Phone:973-525-5461
Practice Address - Fax:862-397-4603
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054135001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0541214Medicaid