MEDICARE: STANLEY GREENBERG PH.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	003840-1	NY

General Provider Information

NPI Number	:	1083863674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STANLEY GREENBERG PH.D

Provider Business Mailing Address
First Line	:	1 OLD COUNTRY RD
Second Line	:	SUITE 271
City	:	CARLE PLACE
State	:	NY
Zip	:	11514-1801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	89 S ROUTE 9W
Second Line	:
City	:	HAVERSTRAW
State	:	NY
Zip	:	10927-1700
Country	:	US
Telephone Number	:	845-429-4300
Fax Number	:	845-429-6267

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2008
Last Update Date	:	09/18/2008

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