MEDICARE: GREENBERG & ASSOCIATES

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942822051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREENBERG & ASSOCIATES

Provider Business Mailing Address
First Line	:	3628 BOULEVARD # B
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1342
Country	:	US
Telephone Number	:	804-520-6868
Fax Number	:	804-597-0199

Provider Business Practice Location Address
First Line	:	3628 BOULEVARD # B
Second Line	:
City	:	COLONIAL HEIGHTS
State	:	VA
Zip	:	23834-1342
Country	:	US
Telephone Number	:	804-520-6868
Fax Number	:	804-597-0199

Authorized Official
Title or Position	:	OWNER
Name	:	DR. BYRON EARLE GREENBERG
Credential	:	PH.D, MHP
Telephone Number	:	804-520-6868

Provider Enumeration Date	:	05/12/2020
Last Update Date	:	05/20/2024

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