Provider Demographics
NPI:1174361190
Name:GREENBERG, JEREMY H (BCBA-D)
Entity type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:H
Last Name:GREENBERG
Suffix:
Gender:M
Credentials:BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1318 WAUKEGAN RD
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-3022
Mailing Address - Country:US
Mailing Address - Phone:224-284-6013
Mailing Address - Fax:
Practice Address - Street 1:1318 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3022
Practice Address - Country:US
Practice Address - Phone:224-284-6013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-15
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1-00-0018103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst