1831105071 NPI number — MS. JUDY SCHULMAN GREENBERG M.ED, LCSW

Table of content: MS. JUDY SCHULMAN GREENBERG M.ED, LCSW (NPI 1831105071)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831105071 NPI number — MS. JUDY SCHULMAN GREENBERG M.ED, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENBERG
Provider First Name:
JUDY
Provider Middle Name:
SCHULMAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GREENBERG
Provider Other First Name:
JUDITH
Provider Other Middle Name:
S
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1831105071
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2790 SANDY PLAINS RD
Provider Second Line Business Mailing Address:
SUITE 203
Provider Business Mailing Address City Name:
MARIETTA
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30066-4373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-579-0880
Provider Business Mailing Address Fax Number:
770-579-0897

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2790 SANDY PLAINS RD
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
MARIETTA
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30066-4373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-579-0880
Provider Business Practice Location Address Fax Number:
770-579-0897
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  CSW001686 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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