Individual
DR. GARY GREENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
400 BAYONET ST, NEW LONDON, CT 06320-2600
(860) 443-4163
Mailing address
400 BAYONET ST, NEW LONDON, CT 06320-2600
(860) 443-4163
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
00114
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
240000114CT01
ANTHEM PROVIDER NUMBER
CT
Enumeration date
07/31/2006
Last updated
07/08/2007
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