Provider Demographics
NPI:1720006034
Name:GREENBERG, LAURI ILENE (MA,CCC)
Entity Type:Individual
Prefix:MRS
First Name:LAURI
Middle Name:ILENE
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:MA,CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 GREENBRIAR RD
Mailing Address - Street 2:
Mailing Address - City:MARMORA
Mailing Address - State:NJ
Mailing Address - Zip Code:08223-1912
Mailing Address - Country:US
Mailing Address - Phone:609-390-3881
Mailing Address - Fax:609-927-6560
Practice Address - Street 1:7 GREENBRIAR RD
Practice Address - Street 2:
Practice Address - City:MARMORA
Practice Address - State:NJ
Practice Address - Zip Code:08223-1912
Practice Address - Country:US
Practice Address - Phone:609-390-3881
Practice Address - Fax:609-927-6560
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00047200235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist