Provider Demographics
NPI:1124107628
Name:GREENBERG, RONNIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:RONNI
Other - Middle Name:
Other - Last Name:GREENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:1300 W BELMONT AVE
Mailing Address - Street 2:SUITE 407
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-3200
Mailing Address - Country:US
Mailing Address - Phone:773-405-6007
Mailing Address - Fax:
Practice Address - Street 1:1300 W BELMONT AVE
Practice Address - Street 2:SUITE 407
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60657-3200
Practice Address - Country:US
Practice Address - Phone:773-405-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041001A103TC0700X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL7999116OtherAETNA PROVIDER NUMBER
IL21623217OtherBCBS PROVIDER NUMBER
IL207311OtherVALUE OPTIONS PROVIDER