Provider Demographics
NPI:1639132657
Name:GREENBERG-CARDILLO, LAURIE LEE (PSYD)
Entity type:Individual
Prefix:
First Name:LAURIE
Middle Name:LEE
Last Name:GREENBERG-CARDILLO
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 1:208 W 105TH ST
Mailing Address - Street 2:#1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-3983
Mailing Address - Country:US
Mailing Address - Phone:212-430-2617
Mailing Address - Fax:212-844-1831
Practice Address - Street 1:113 UNIVERSITY PL
Practice Address - Street 2:10015
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4527
Practice Address - Country:US
Practice Address - Phone:212-420-2617
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013522103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVN1191Medicare ID - Type UnspecifiedPROVIDER NUMBER