Healthcare Provider Details

I. General information

NPI: 1376167882
Provider Name (Legal Business Name): CHLOE GREENBAUM, PH.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2020
Last Update Date: 05/31/2020
Certification Date: 05/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

872 MASSACHUSETTS AVENUE SUITE 2-1
CAMBRIDGE MA
02139
US

IV. Provider business mailing address

872 MASSACHUSETTS AVENUE SUITE 2-1
CAMBRIDGE MA
02139
US

V. Phone/Fax

Practice location:
  • Phone: 617-807-0773
  • Fax:
Mailing address:
  • Phone: 914-420-7166
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0100X
TaxonomyHealth Service Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHLOE ALEXA GREENBAUM
Title or Position: LICENSED PSYCHOLOGIST
Credential: PHD
Phone: 617-807-0773