Provider Demographics
NPI:1154089704
Name:PEARLBERG, STANLEY MARVIN (LMSW)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:MARVIN
Last Name:PEARLBERG
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:STANLEY
Other - Middle Name:MARVIN
Other - Last Name:PEARLBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:194 NASSAU AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-5362
Mailing Address - Country:US
Mailing Address - Phone:917-746-7354
Mailing Address - Fax:
Practice Address - Street 1:194 NASSAU AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-5362
Practice Address - Country:US
Practice Address - Phone:917-746-7354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-01
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106700-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health