Provider Demographics
NPI:1942822051
Name:GREENBERG & ASSOCIATES
Entity type:Organization
Organization Name:GREENBERG & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:EARLE
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, MHP
Authorized Official - Phone:804-520-6868
Mailing Address - Street 1:3628 BOULEVARD # B
Mailing Address - Street 2:
Mailing Address - City:COLONIAL HEIGHTS
Mailing Address - State:VA
Mailing Address - Zip Code:23834-1342
Mailing Address - Country:US
Mailing Address - Phone:804-520-6868
Mailing Address - Fax:804-597-0199
Practice Address - Street 1:3628 BOULEVARD # B
Practice Address - Street 2:
Practice Address - City:COLONIAL HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:23834-1342
Practice Address - Country:US
Practice Address - Phone:804-520-6868
Practice Address - Fax:804-597-0199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-12
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010188903Medicaid