Provider Demographics
NPI:1538202775
Name:GREENBERG, REBECCA A (PSYD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5060 25TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1370
Mailing Address - Country:US
Mailing Address - Phone:206-488-8226
Mailing Address - Fax:
Practice Address - Street 1:5060 25TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106-1370
Practice Address - Country:US
Practice Address - Phone:206-488-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY00003448103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8473365Medicaid
WA8864367Medicare ID - Type UnspecifiedUW PHYSICIANS