Provider Demographics
NPI:1053789032
Name:E RUTH GREENBERG LPC LLC
Entity type:Organization
Organization Name:E RUTH GREENBERG LPC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:E RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:GREENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-997-1170
Mailing Address - Street 1:39 N MAIN ST
Mailing Address - Street 2:PO BOX 964
Mailing Address - City:KENT
Mailing Address - State:CT
Mailing Address - Zip Code:06757-1513
Mailing Address - Country:US
Mailing Address - Phone:203-997-1170
Mailing Address - Fax:
Practice Address - Street 1:39 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:CT
Practice Address - Zip Code:06757-1513
Practice Address - Country:US
Practice Address - Phone:203-997-1170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-09
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000645101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty