Provider Demographics
NPI:1851415699
Name:GREENBERG, JUDITH LYNN (LCSW)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:LYNN
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 WEST 89 STREET
Mailing Address - Street 2:APT. 1C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-1803
Mailing Address - Country:US
Mailing Address - Phone:212-873-4705
Mailing Address - Fax:
Practice Address - Street 1:109 EAST 36 STREET
Practice Address - Street 2:STE. 5R
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016
Practice Address - Country:US
Practice Address - Phone:212-873-4705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO 13422-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN8C921OtherEMPIRE MAGELLAN
NYN8C921Medicare ID - Type Unspecified