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NPI Code Detail

MEDICARE: MR. EVAN GREENBERG MSW, LCSW, LAMFT

MEDICARE: MR. EVAN GREENBERG MSW, LCSW, LAMFT
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
11041C0700XClinical Social Worker44SC06550400NJ

General Provider Information

NPI Number : 1487497046
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EVAN GREENBERG MSW, LCSW, LAMFT
Provider Business Mailing Address
First Line : 10 ROCKY WAY
Second Line :
City : WEST ORANGE
State : NJ
Zip : 07052-4971
Country : US
Telephone Number : 917-620-1139
Fax Number :
Provider Business Practice Location Address
First Line : 256 BROAD ST STE 2E
Second Line :
City : BLOOMFIELD
State : NJ
Zip : 07003-2766
Country : US
Telephone Number : 917-620-1139
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2024
Last Update Date : 01/24/2026

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