Active NPI
Gary Greenberg, PH.D.
- Professional Counselor
- New London, CT
National Provider Identifier
1386650513
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 00114
- Practice address
- 400 Bayonet St
New London, CT 06320-2600 - Phone
- (860) 443-4163
- NPI assigned
- Jul 31, 2006
- Last updated
- Jul 8, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 00114 | CT | Primary |
Addresses
Primary practice location
400 Bayonet St
New London, CT 06320-2600
Mailing address
400 Bayonet St
New London, CT 06320-2600
Phone (860) 443-4163
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 240000114CT01 | Other | CT | ANTHEM PROVIDER NUMBER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CT
- 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 |
|---|---|---|---|---|
| I20240726002642 | CT | Practitioner - Mental Health Counselor | 5395281232 | Practice locations: New London, CT |
Care Compare profile
Medicare Care Compare- Specialty
- Mental Health Counselor
- Education
- Other, 1992
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
400 Bayonet St
Suite 202
New London, CT 06320-2600
Phone (860) 443-4163
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00114 | CT | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154304000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1386650513",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "400 BAYONET ST",
"city": "NEW LONDON",
"state": "CT",
"postal_code": "063202600",
"telephone_number": "860-443-4163"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 BAYONET ST",
"city": "NEW LONDON",
"state": "CT",
"postal_code": "063202600",
"telephone_number": "860-443-4163"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREENBERG",
"first_name": "GARY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "CT",
"license": "00114",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PROVIDER NUMBER",
"identifier": "240000114CT01",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in New London, CT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.