Healthcare Provider Details

I. General information

NPI: 1538202775
Provider Name (Legal Business Name): REBECCA A GREENBERG PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 01/10/2022
Certification Date: 01/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 25TH AVE SW
SEATTLE WA
98106-1370
US

IV. Provider business mailing address

5060 25TH AVE SW
SEATTLE WA
98106-1370
US

V. Phone/Fax

Practice location:
  • Phone: 206-488-8226
  • Fax:
Mailing address:
  • Phone: 206-488-8226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPY00003448
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: