Provider Demographics
NPI:1114914686
Name:EDELBERG, MARLA J (MSW, ACSW)
Entity Type:Individual
Prefix:MS
First Name:MARLA
Middle Name:J
Last Name:EDELBERG
Suffix:
Gender:F
Credentials:MSW, ACSW
Other - Prefix:MRS
Other - First Name:MARLA
Other - Middle Name:
Other - Last Name:EDELBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:8226 262ND ST
Mailing Address - Street 2:
Mailing Address - City:FLORAL PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1513
Mailing Address - Country:US
Mailing Address - Phone:718-347-0360
Mailing Address - Fax:718-347-0360
Practice Address - Street 1:82-26 262ND STREET
Practice Address - Street 2:
Practice Address - City:FLORAL PARK
Practice Address - State:NY
Practice Address - Zip Code:11004
Practice Address - Country:US
Practice Address - Phone:718-347-0360
Practice Address - Fax:718-347-0360
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYL2205111041C0700X
NYR#22051-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3226225OtherOXFORD
NY0049430OtherVBH
NY49430Medicare PIN