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General NPI Number Information
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NPI Number | 1336119346
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Entity Type | Individual
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Provider Name | GLEN DAVID GREENBERG PHD
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Gender | Male
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Dates
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Enumeration Date | 01/23/2006
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Last Update Date | 04/30/2018
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Provider Practice Location Address
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Address Line | 774 CHRISTIANA RD STE 201A
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City | NEWARK
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State | DE
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Zip | 19713-4221
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Country | US
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Telephone | 610-566-0501
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Fax | 610-566-0502
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Provider Business Mailing Address
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Address Line | PO BOX 594
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City | WESTTOWN
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State | PA
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Zip | 19395-0594
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Country | US
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Telephone | 610-566-0501
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Fax | 610-566-0502
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PS 004797-L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | B1 0000441
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License Number State | DE
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS 004797-L
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License Number State | PA
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Taxonomy #4
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | B1 0000441
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License Number State | DE
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