Provider Demographics
NPI:1609917970
Name:GREENBERG, MAIDA JABLON (EDD PSYCHOLOGIST)
Entity Type:Individual
Prefix:
First Name:MAIDA
Middle Name:JABLON
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:EDD PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 BALLARD STREET
Mailing Address - Street 2:
Mailing Address - City:NEWTON CENTRE
Mailing Address - State:MA
Mailing Address - Zip Code:02459
Mailing Address - Country:US
Mailing Address - Phone:617-244-2813
Mailing Address - Fax:617-255-5071
Practice Address - Street 1:48 BALLARD STREET
Practice Address - Street 2:
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-244-2813
Practice Address - Fax:617-255-5071
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4081103TC0700X
103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAGRWO3999OtherBC BS PROVIDER