Provider Demographics
NPI:1831105071
Name:GREENBERG, JUDY SCHULMAN (MED, LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:SCHULMAN
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:MED, LCSW
Other - Prefix:MS
Other - First Name:JUDITH
Other - Middle Name:S
Other - Last Name:GREENBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MED, LCSW
Mailing Address - Street 1:2790 SANDY PLAINS RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4373
Mailing Address - Country:US
Mailing Address - Phone:770-579-0880
Mailing Address - Fax:770-579-0897
Practice Address - Street 1:2790 SANDY PLAINS RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4373
Practice Address - Country:US
Practice Address - Phone:770-579-0880
Practice Address - Fax:770-579-0897
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0016861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAR13090Medicare ID - Type Unspecified