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General NPI Number Information
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NPI Number | 1801088828
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Entity Type | Individual
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Provider Name | JUDY BERYL GREENBERG M.A.
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Gender | Female
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 08/14/2007
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Provider Practice Location Address
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Address Line | 167 MAIN ST
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City | BRATTLEBORO
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State | VT
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Zip | 05301-7128
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Country | US
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Telephone | 802-254-7395
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 6372
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City | BRATTLEBORO
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State | VT
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Zip | 05302-6372
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Country | US
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Telephone | 802-254-7395
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Fax |
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 417
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License Number State | VT
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