Provider Demographics
NPI:1164579892
Name:STAMBERG, MARCIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:
Last Name:STAMBERG
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 KIRA LN
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3735
Mailing Address - Country:US
Mailing Address - Phone:201-894-1196
Mailing Address - Fax:201-894-8195
Practice Address - Street 1:16 KIRA LN
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3735
Practice Address - Country:US
Practice Address - Phone:201-894-1196
Practice Address - Fax:201-894-8195
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000146001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ745330STMedicare ID - Type Unspecified