Provider Demographics
NPI:1972514685
Name:GREENBERG, MICHAEL S (PHV)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:PHV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 COUNTY ROAD 1
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698
Mailing Address - Country:US
Mailing Address - Phone:727-791-0886
Mailing Address - Fax:727-735-0859
Practice Address - Street 1:1201 COUNTY ROAD 1
Practice Address - Street 2:SUITE A
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698
Practice Address - Country:US
Practice Address - Phone:727-791-0886
Practice Address - Fax:727-735-0859
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLP10003816103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75916Medicare ID - Type Unspecified