Provider Demographics
NPI:1952496580
Name:GREENBERG, SHEILA ANN (PHD)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:ANN
Last Name:GREENBERG
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 1:2804 FORUM BLVD
Mailing Address - Street 2:STE 3A
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203
Mailing Address - Country:US
Mailing Address - Phone:573-446-6290
Mailing Address - Fax:573-446-0618
Practice Address - Street 1:2804 FORUM BLVD
Practice Address - Street 2:STE 3A
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203
Practice Address - Country:US
Practice Address - Phone:573-446-6290
Practice Address - Fax:573-446-0618
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01589103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical