MEDICARE: MR. ALAN ROBERT GREENWALD MA, NCSP

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	103TS0200X	School Psychologist		AZ

General Provider Information

NPI Number	:	1790905388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALAN ROBERT GREENWALD MA, NCSP

Provider Business Mailing Address
First Line	:	3854 E NAMBE ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-3879
Country	:	US
Telephone Number	:	480-893-6118
Fax Number	:

Provider Business Practice Location Address
First Line	:	3854 E NAMBE ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85044-3879
Country	:	US
Telephone Number	:	480-893-6118
Fax Number	:

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	07/26/2007

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