Provider Demographics
NPI:1699175414
Name:GREENBERG, REBECCA (LCPC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13333 BONDY WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2124
Mailing Address - Country:US
Mailing Address - Phone:301-869-8975
Mailing Address - Fax:
Practice Address - Street 1:121 CONGRESSIONAL LN
Practice Address - Street 2:STE 604
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1542
Practice Address - Country:US
Practice Address - Phone:240-604-4519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-28
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC5633101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD541237400Medicaid
MD836047OtherVALUE OPTIONS