Provider Demographics
NPI:1851545297
Name:GREENBERG, JENNIFER ALIZA (MA, CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:ALIZA
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:16 N CHATSWORTH AVE
Mailing Address - Street 2:APT 201
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2143
Mailing Address - Country:US
Mailing Address - Phone:914-630-1457
Mailing Address - Fax:
Practice Address - Street 1:16 N CHATSWORTH AVE
Practice Address - Street 2:APT 201
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2143
Practice Address - Country:US
Practice Address - Phone:914-630-1457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009224235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist