Provider Demographics
NPI:1629135769
Name:GREENLAW, MARYMERLE ELIZABETH (EDS)
Entity Type:Individual
Prefix:
First Name:MARYMERLE
Middle Name:ELIZABETH
Last Name:GREENLAW
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ROGER AVE
Mailing Address - Street 2:
Mailing Address - City:CRANFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:07016-2715
Mailing Address - Country:US
Mailing Address - Phone:908-497-9140
Mailing Address - Fax:
Practice Address - Street 1:915 BROADWAY
Practice Address - Street 2:7TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7108
Practice Address - Country:US
Practice Address - Phone:212-989-2990
Practice Address - Fax:212-260-3653
Is Sole Proprietor?:No
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002378-1101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional