Provider Demographics
NPI:1962515726
Name:GREENBERG, ELLEN (MA)
Entity type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 PIERCE ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-5149
Mailing Address - Country:US
Mailing Address - Phone:570-718-1760
Mailing Address - Fax:570-718-1763
Practice Address - Street 1:250 PIERCE ST
Practice Address - Street 2:SUITE 214
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-5149
Practice Address - Country:US
Practice Address - Phone:570-718-1760
Practice Address - Fax:570-718-1763
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008060L103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA097313Medicare ID - Type Unspecified