MEDICARE: DR. DAVID J GREENWALD PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	4267	OH
2	103TB0200X	Cognitive & Behavioral Psychologist	PS-005374-L	PA
3	103TC0700X	Clinical Psychologist	4267	OH
4	103TC0700X	Clinical Psychologist	PS-005374-L	PA
5	103TB0200X	Cognitive & Behavioral Psychologist		IL
6	103TC0700X	Clinical Psychologist		IL

General Provider Information

NPI Number	:	1184747560
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID J GREENWALD PH.D.

Provider Business Mailing Address
First Line	:	6580 SOSNA DR
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-2222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6580 SOSNA DR
Second Line	:
City	:	FAIRFIELD
State	:	OH
Zip	:	45014-2222
Country	:	US
Telephone Number	:	513-942-3304
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	01/29/2008

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