Healthcare Provider Details

I. General information

NPI: 1215083472
Provider Name (Legal Business Name): JEANINE R GREENBAUM LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 BOSLEY AVE
TOWSON MD
21204-4029
US

IV. Provider business mailing address

7900 LONG MEADOW RD
PIKESVILLE MD
21208-3020
US

V. Phone/Fax

Practice location:
  • Phone: 410-823-0151
  • Fax:
Mailing address:
  • Phone: 410-823-0151
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number05817
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: