Healthcare Provider Details

I. General information

NPI: 1114062015
Provider Name (Legal Business Name): MARIAN S GREENBERG MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 MAIN ST
MIDDLEBURY VT
05753-1459
US

IV. Provider business mailing address

335 SPARROW HAWK RD
VERGENNES VT
05491-9447
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-6751
  • Fax:
Mailing address:
  • Phone: 802-877-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number089-0000408
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: