Provider Demographics
NPI:1215083472
Name:GREENBAUM, JEANINE R (LCSW-C)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:R
Last Name:GREENBAUM
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7900 LONG MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3020
Mailing Address - Country:US
Mailing Address - Phone:410-823-0151
Mailing Address - Fax:
Practice Address - Street 1:608 BOSLEY AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-4029
Practice Address - Country:US
Practice Address - Phone:410-823-0151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD058171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD596QMedicare ID - Type UnspecifiedPROVIDER NUMBER