Provider Demographics
NPI:1972609865
Name:GREENFELD, MARK A (LSCW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:A
Last Name:GREENFELD
Suffix:
Gender:M
Credentials:LSCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 SULLYS TRAIL
Mailing Address - Street 2:SUITE D
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534
Mailing Address - Country:US
Mailing Address - Phone:585-425-3700
Mailing Address - Fax:
Practice Address - Street 1:55 SULLYS TRAIL
Practice Address - Street 2:SUITE D
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534
Practice Address - Country:US
Practice Address - Phone:585-425-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYMOF625OtherPREFERRED CARE
NYIA0811Medicare ID - Type Unspecified