MEDICARE: DR. ALAN LEBLANG GREENBAUM 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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1174663348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALAN LEBLANG GREENBAUM PH.D.

Provider Business Mailing Address
First Line	:	8505 E VALLEY VIEW RD
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85250-6768
Country	:	US
Telephone Number	:	480-484-5077
Fax Number	:

Provider Business Practice Location Address
First Line	:	6720 E CONTINENTAL DR
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85257-3226
Country	:	US
Telephone Number	:	480-484-5828
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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