Provider Demographics
NPI:1598154866
Name:GREENBAUM, JENNIFER LEAH (LPC)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LEAH
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4842 SMICK ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19127-1911
Mailing Address - Country:US
Mailing Address - Phone:856-313-7895
Mailing Address - Fax:
Practice Address - Street 1:237 W LANCASTER AVE
Practice Address - Street 2:SUITE 115
Practice Address - City:DEVON
Practice Address - State:PA
Practice Address - Zip Code:19333-1592
Practice Address - Country:US
Practice Address - Phone:610-687-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC007814101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional