Provider Demographics
NPI:1568929289
Name:GREENBERG, SCOTT
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2030 DIVISION ST STE B
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8014
Mailing Address - Country:US
Mailing Address - Phone:360-676-2020
Mailing Address - Fax:360-734-2106
Practice Address - Street 1:2030 DIVISION ST STE B
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-8014
Practice Address - Country:US
Practice Address - Phone:360-676-2020
Practice Address - Fax:360-734-2106
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2021-12-10
Deactivation Date:2021-12-10
Deactivation Code:
Reactivation Date:2021-12-10
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician