Provider Demographics
NPI:1326415290
Name:MARROQUIN, MICHAEL (PHD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:MARROQUIN
Suffix:
Gender:M
Credentials:PHD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26062 73RD AVE
Mailing Address - Street 2:
Mailing Address - City:GLEN OAKS
Mailing Address - State:NY
Mailing Address - Zip Code:11004-1030
Mailing Address - Country:US
Mailing Address - Phone:917-373-3041
Mailing Address - Fax:
Practice Address - Street 1:26062 73RD AVE
Practice Address - Street 2:
Practice Address - City:GLEN OAKS
Practice Address - State:NY
Practice Address - Zip Code:11004-1030
Practice Address - Country:US
Practice Address - Phone:917-373-3041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-27
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000035-1103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst