Provider Demographics
NPI:1801942016
Name:GREENBERG, GARY (PHD)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 SHERMER RD
Mailing Address - Street 2:348
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-5340
Mailing Address - Country:US
Mailing Address - Phone:847-205-1955
Mailing Address - Fax:847-205-1977
Practice Address - Street 1:1500 SHERMER RD
Practice Address - Street 2:348
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-5340
Practice Address - Country:US
Practice Address - Phone:847-205-1955
Practice Address - Fax:847-205-1977
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL71-1084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1013082Medicare UPIN
IL290609Medicare UPIN
IL1672958Medicare UPIN
IL81337Medicare UPIN
IL54383000Medicare UPIN
IL366610Medicare ID - Type Unspecified
IL5902443Medicare UPIN