Provider Demographics
NPI:1871588392
Name:GREENBERG, LESLIE BERKELHAMMER (PHD)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:BERKELHAMMER
Last Name:GREENBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4713 HARVEST GLEN WAY
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-2517
Mailing Address - Country:US
Mailing Address - Phone:804-833-3567
Mailing Address - Fax:804-740-2154
Practice Address - Street 1:4713 HARVEST GLEN WAY
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23059-2517
Practice Address - Country:US
Practice Address - Phone:804-833-3567
Practice Address - Fax:804-740-2154
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-12
Last Update Date:2018-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
VA0810004988103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist