=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619198397
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BREE GREENBERG-BENJAMIN LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 34 PATCHEN RD
-----------------------------------------------------
City | SOUTH BURLINGTON
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05403-5704
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-658-4208
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 770 HARVEY FARM RD
-----------------------------------------------------
City | WATERBURY CENTER
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05677-7127
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-244-6171
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 100-0000051
-----------------------------------------------------
License Number State | VT
-----------------------------------------------------