Provider Demographics
NPI:1306106711
Name:SYDNOR-GREENBERG, JAMES MARK (PHD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MARK
Last Name:SYDNOR-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 1:4701 WILLARD AVE.
Mailing Address - Street 2:SUITE 419
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815
Mailing Address - Country:US
Mailing Address - Phone:703-536-5405
Mailing Address - Fax:301-718-2677
Practice Address - Street 1:4701 WILLARD AVE
Practice Address - Street 2:SUITE 419
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815
Practice Address - Country:US
Practice Address - Phone:703-536-5405
Practice Address - Fax:301-718-2677
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-18
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2681103T00000X
VA1772103T00000X
DC1625103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist