Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | PS004037L | PA |
NPI | 1023005584 |
---|---|
Provider Name | Ruth L. Greenberg |
First Address | Phila, PA 19102-3604 |
Second Address | Phila, PA 19102-3604 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2005 |
Last Update Date | 08/07/2007 |