Provider Demographics
NPI:1528451515
Name:GREENWALD, RICKY (PSYD)
Entity type:Individual
Prefix:DR
First Name:RICKY
Middle Name:
Last Name:GREENWALD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2034
Mailing Address - Country:US
Mailing Address - Phone:413-774-2340
Mailing Address - Fax:
Practice Address - Street 1:320 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:MA
Practice Address - Zip Code:01062-2767
Practice Address - Country:US
Practice Address - Phone:413-774-2340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-15
Last Update Date:2015-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8997103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical