MEDICARE: JULIA BETH GREENBAUM LMSW

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	1041C0700X	Clinical Social Worker	6801090285	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	6801090285	OTHER	MI	PROFESSION AND LICENSE/REGISTRATION INFORMATION

General Provider Information

NPI Number	:	1902227325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA BETH GREENBAUM LMSW

Provider Business Mailing Address
First Line	:	2192 OXFORD RD
Second Line	:
City	:	BERKLEY
State	:	MI
Zip	:	48072-1738
Country	:	US
Telephone Number	:	248-798-7463
Fax Number	:

Provider Business Practice Location Address
First Line	:	2192 OXFORD RD
Second Line	:
City	:	BERKLEY
State	:	MI
Zip	:	48072-1738
Country	:	US
Telephone Number	:	248-798-7463
Fax Number	:

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

Provider Enumeration Date	:	01/02/2014
Last Update Date	:	01/02/2014

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