Doctor Name: | DR. GLEN DAVID GREENBERG |
NPI Number: | 1336119346 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PHD |
License Number: | PS 004797-L |
Business Practice Address: | 280 N Providence Rd Media, PA - 190633527 |
Business Phone Number: | 6105660501 |
Business Fax Number: | 6105660502 |
Mailing Address: | Po Box 594, WESTTOWN |
State: | PA |
Postal Code: | 193950594 |
Phone Number: | 6105660501 |
Fax Number: | 6105660502 |
NPI Enumeration Date: | 01/23/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | PS 004797-L |
Healthcare Provider Taxonomy: (Secondary) | X |
State: | PA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |