Provider Demographics
NPI:1316981285
Name:GREENWALD, ELAINE K (PHD)
Entity type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:K
Last Name:GREENWALD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 VAUXHALL CT
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747
Mailing Address - Country:US
Mailing Address - Phone:631-491-5050
Mailing Address - Fax:631-253-0471
Practice Address - Street 1:1120 OLD COUNTRY RD
Practice Address - Street 2:SUITE 302
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803
Practice Address - Country:US
Practice Address - Phone:631-491-5050
Practice Address - Fax:631-253-0471
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0081901103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R51478Medicare UPIN
V25232Medicare ID - Type Unspecified