Provider Demographics
NPI:1922149129
Name:GREENBAUM, ROSALIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:530 E 72ND ST
Mailing Address - Street 2:PENTHOUSE C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10021-4855
Mailing Address - Country:US
Mailing Address - Phone:212-734-0892
Mailing Address - Fax:212-734-0892
Practice Address - Street 1:530 E 72ND ST
Practice Address - Street 2:PENTHOUSE C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10021-4855
Practice Address - Country:US
Practice Address - Phone:212-734-0892
Practice Address - Fax:212-734-0892
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT981103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical