Provider Demographics
NPI:1972052595
Name:GREENFEST, CLAIRE
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:
Last Name:GREENFEST
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3711 SW 160TH AVE.
Mailing Address - Street 2:APT. 107
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33027
Mailing Address - Country:US
Mailing Address - Phone:305-505-6275
Mailing Address - Fax:
Practice Address - Street 1:3711 SW 160TH AVE
Practice Address - Street 2:APT. 107
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33027-4658
Practice Address - Country:US
Practice Address - Phone:305-505-6275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG651-113-90-844-0103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral