Provider Demographics
NPI:1538280060
Name:GREGORY S. GREENBERG, PH.D., PLLC
Entity Type:Organization
Organization Name:GREGORY S. GREENBERG, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER & MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:425-637-7700
Mailing Address - Street 1:1601 114TH AVE SE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6950
Mailing Address - Country:US
Mailing Address - Phone:425-637-7700
Mailing Address - Fax:425-635-0405
Practice Address - Street 1:1601 114TH AVE SE
Practice Address - Street 2:SUITE 107
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-6950
Practice Address - Country:US
Practice Address - Phone:425-637-7700
Practice Address - Fax:425-635-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00001293103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty