Provider Demographics
NPI:1902227325
Name:GREENBAUM, JULIA BETH (LMSW)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:BETH
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2192 OXFORD RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1738
Mailing Address - Country:US
Mailing Address - Phone:248-798-7463
Mailing Address - Fax:
Practice Address - Street 1:2192 OXFORD RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1738
Practice Address - Country:US
Practice Address - Phone:248-798-7463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-02
Last Update Date:2014-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010902851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801090285OtherPROFESSION AND LICENSE/REGISTRATION INFORMATION