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General NPI Number Information
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NPI Number | 1184950933
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Entity Type | Organization
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Legal Business Name | RICHARD S. GREENBAUM PHD, PA
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Dates
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Enumeration Date | 10/29/2009
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Last Update Date | 10/29/2009
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Provider Practice Location Address
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Address Line | 1175 N.E. 125 ST. #201
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City | NO. MIAMI
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State | FL
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Zip | 33161-2218
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Country | US
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Telephone | 305-891-4821
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Fax | 305-891-4271
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Provider Business Mailing Address
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Address Line | 1175 N.E. 125 ST. #201
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City | NO. MIAMI
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State | FL
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Zip | 33161-2218
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Country | US
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Telephone | 305-891-4821
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Fax | 305-891-4271
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD S GREENBAUM
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Credential | PHD, P.A.
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Telephone | 305-891-4821
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY2247
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License Number State | FL
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