Provider Demographics
NPI:1588722557
Name:GREENWALD, DEBORAH FAY (PHD CLINICAL PSYCH)
Entity type:Individual
Prefix:DR
First Name:DEBORAH
Middle Name:FAY
Last Name:GREENWALD
Suffix:
Gender:F
Credentials:PHD CLINICAL PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 S GREAT RD
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:MA
Mailing Address - Zip Code:01773-4700
Mailing Address - Country:US
Mailing Address - Phone:781-259-8122
Mailing Address - Fax:781-259-3739
Practice Address - Street 1:112 S GREAT RD
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:MA
Practice Address - Zip Code:01773-4700
Practice Address - Country:US
Practice Address - Phone:781-259-8122
Practice Address - Fax:781-259-3739
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2409103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA170824OtherMAGELLAN (MBC)
MA2409OtherPSYCHOLOGIST LICENSE-HSP
MAW02546OtherBLUE CROSS BLUE SHIELD
MAW02546OtherBLUE CROSS BLUE SHIELD