MEDICARE: DR. ISAAC GREENBERG 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	103TC0700X	Clinical Psychologist	PY1628-PR	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	PY1628-PR	OTHER	MA	HEALTH PROVIDER LICENSE

General Provider Information

NPI Number	:	1558366690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ISAAC GREENBERG PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 591
Second Line	:
City	:	LEXINGTON
State	:	MA
Zip	:	02420-0005
Country	:	US
Telephone Number	:	781-862-9173
Fax Number	:

Provider Business Practice Location Address
First Line	:	94 PLEASANT ST
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02476-6535
Country	:	US
Telephone Number	:	781-862-9173
Fax Number	:

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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