1699175414 NPI number — REBECCA GREENBERG LCPC

Table of content: REBECCA GREENBERG LCPC (NPI 1699175414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699175414 NPI number — REBECCA GREENBERG LCPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GREENBERG
Provider First Name:
REBECCA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699175414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13333 BONDY WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH POTOMAC
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20878-2124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-869-8975
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 CONGRESSIONAL LN
Provider Second Line Business Practice Location Address:
STE 604
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20852-1542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-604-4519
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2014

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: 101YP2500X , with the licence number:  LC5633 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 541237400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 836047 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".