Provider Demographics
NPI:1740495266
Name:GREENWALD, KENNETH S (LCSW)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:S
Last Name:GREENWALD
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:336 W END AVE
Mailing Address - Street 2:SUITE 19A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-8116
Mailing Address - Country:US
Mailing Address - Phone:212-724-5510
Mailing Address - Fax:212-724-5510
Practice Address - Street 1:336 W END AVE
Practice Address - Street 2:SUITE 19A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-8116
Practice Address - Country:US
Practice Address - Phone:212-724-5510
Practice Address - Fax:212-724-5510
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR071074-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR071074-1OtherNEW YORK STATE