Provider Demographics
NPI:1700076122
Name:GREENBERG, VANESSA CARRIE (MA CCC)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:CARRIE
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:MA CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 CRUM CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4144
Mailing Address - Country:US
Mailing Address - Phone:845-708-7713
Mailing Address - Fax:845-708-7713
Practice Address - Street 1:2 CRUM CREEK RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4144
Practice Address - Country:US
Practice Address - Phone:845-708-7713
Practice Address - Fax:845-708-7713
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007959 01235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist