Provider Demographics
NPI:1063516185
Name:GREENWOOD, DAVID BRIAN (LISW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRIAN
Last Name:GREENWOOD
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 UNIVERSITY AVENUE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:WINDSOR HEIGHTS
Mailing Address - State:IA
Mailing Address - Zip Code:50311-1505
Mailing Address - Country:US
Mailing Address - Phone:515-243-1020
Mailing Address - Fax:515-883-1946
Practice Address - Street 1:6900 UNIVERSITY AVENUE
Practice Address - Street 2:SUITE 135
Practice Address - City:WINDSOR HEIGHTS
Practice Address - State:IA
Practice Address - Zip Code:50311-1505
Practice Address - Country:US
Practice Address - Phone:515-243-1020
Practice Address - Fax:515-883-1946
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA010691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA238645OtherMIDLANDS CHOICE PROVID #
IA48248OtherWELLMARK BCBS PROVIDER NU
IA128731OtherVALUE OPTIONS PROVIDER #