Provider Demographics
NPI:1861863417
Name:GREENWALD, MEREDITH (MA, BCBA)
Entity Type:Individual
Prefix:MS
First Name:MEREDITH
Middle Name:
Last Name:GREENWALD
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E 79TH ST
Mailing Address - Street 2:APT 6U
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10075-1034
Mailing Address - Country:US
Mailing Address - Phone:917-566-5863
Mailing Address - Fax:
Practice Address - Street 1:435 E 79TH ST
Practice Address - Street 2:APT 6U
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-1034
Practice Address - Country:US
Practice Address - Phone:917-566-5863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-08
Last Update Date:2015-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000761103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst