Provider Demographics
NPI:1891869087
Name:GREENBERG, BYRON EARLE (PHD, MPH)
Entity Type:Individual
Prefix:DR
First Name:BYRON
Middle Name:EARLE
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:PHD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20145 HUNNICUT RD
Mailing Address - Street 2:
Mailing Address - City:DINWIDDIE
Mailing Address - State:VA
Mailing Address - Zip Code:23841-2957
Mailing Address - Country:US
Mailing Address - Phone:804-520-6868
Mailing Address - Fax:
Practice Address - Street 1:205 CHESTERFIELD AVE
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-3722
Practice Address - Country:US
Practice Address - Phone:804-520-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002801103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical