Active NPI
Glen David Greenberg, PHD
- Clinical Neuropsychologist
- Newark, DE
National Provider Identifier
1336119346
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- License
- B1 0000441
- Practice address
- 774 Christiana Rd Ste 201a
Newark, DE 19713-4221 - Phone
- (610) 566-0501
- Fax
- (610) 566-0502
- NPI assigned
- Jan 23, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 4
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | PS 004797-L | PA | |
| Clinical Psychologist | 103TC0700X | B1 0000441 | DE | |
| Clinical Psychologist | 103TC0700X | PS 004797-L | PA | |
| Clinical Neuropsychologist | 103G00000X | B1 0000441 | DE | Primary |
Addresses
Primary practice location
774 Christiana Rd Ste 201a
Newark, DE 19713-4221
Mailing address
PO Box 594
Westtown, PA 19395-0594
Phone (610) 566-0501
Other identifiers 10
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 214951 | Other | COMPPSYCH | |
| 3350135 | Other | AETNA | |
| 001187272003 | Medicaid | PA | |
| 221962 | Other | VALUE OPTIONS | |
| 0488565000 | Other | MAGELLAN | |
| 0427479000 | Other | AMERIHEALTH | |
| 1000033037 | Medicaid | DE | |
| 70659 | Other | CIGNA BEHAVIORAL HEALTH | |
| 001661440 | Other | BS PERSONAL CHOICE | |
| 1000033037 | Other | DELAWARE PHYSICIANS CARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in DE
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050601000996 | DE | Practitioner - Clinical Psychologist | 7315924321 | Practice locations: Rehoboth Beach, DE; Newark, DE |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
774 Christiana Rd
Suite 201a
Newark, DE 19713-4221
Phone (610) 566-0501
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| B1 0000441 | DE | MD | Clinical Psychologist |
| PS 004797-L | PA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525046400000",
"number": "1336119346",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 594",
"city": "WESTTOWN",
"state": "PA",
"postal_code": "193950594",
"telephone_number": "610-566-0501",
"fax_number": "610-566-0502"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "774 CHRISTIANA RD STE 201A",
"city": "NEWARK",
"state": "DE",
"postal_code": "197134221",
"telephone_number": "610-566-0501",
"fax_number": "610-566-0502"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREENBERG",
"first_name": "GLEN",
"middle_name": "DAVID",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-23",
"last_updated": "2018-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "PA",
"license": "PS 004797-L",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "DE",
"license": "B1 0000441",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS 004797-L",
"primary": false
},
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": "DE",
"license": "B1 0000441",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMPPSYCH",
"identifier": "214951",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "3350135",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "001187272003",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "VALUE OPTIONS",
"identifier": "221962",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "0488565000",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AMERIHEALTH",
"identifier": "0427479000",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1000033037",
"state": "DE"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA BEHAVIORAL HEALTH",
"identifier": "70659",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BS PERSONAL CHOICE",
"identifier": "001661440",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELAWARE PHYSICIANS CARE",
"identifier": "1000033037",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Newark, DE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.