Provider Demographics
NPI:1689709727
Name:GREENBERG, SARAH (LICENSED INDEPENDENT)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:LICENSED INDEPENDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CONRY CRESCENT
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:NY
Mailing Address - Zip Code:02130
Mailing Address - Country:US
Mailing Address - Phone:617-524-9218
Mailing Address - Fax:
Practice Address - Street 1:1121 WASHINGTON ST SUITE 4
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02465
Practice Address - Country:US
Practice Address - Phone:617-969-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW102045104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01237OtherBLUE CROSS BLUE SHIELD