Provider Demographics
NPI:1790145266
Name:GREENFARB, JUDITH (LMSW RYT)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:
Last Name:GREENFARB
Suffix:
Gender:F
Credentials:LMSW RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 TENNYSON ROW
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29466-7134
Mailing Address - Country:US
Mailing Address - Phone:843-327-0723
Mailing Address - Fax:
Practice Address - Street 1:925 WAPPOO RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407
Practice Address - Country:US
Practice Address - Phone:843-619-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-26
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC67401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC000000OtherBLUE CROSS BLUE SHIELD