Provider Demographics
NPI:1356482343
Name:MBBERENBERG PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:MBBERENBERG PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-768-2461
Mailing Address - Street 1:86 PROSPECT PARK W
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-3575
Mailing Address - Country:US
Mailing Address - Phone:718-768-2461
Mailing Address - Fax:718-768-2461
Practice Address - Street 1:482 2ND ST
Practice Address - Street 2:SUITE #1
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-2503
Practice Address - Country:US
Practice Address - Phone:718-768-2461
Practice Address - Fax:718-768-2461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005885103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY056183OtherVALUEOPTIONS PROVIDER ID
NY6804058OtherGHI PROVIDER ID
NYP2047617OtherOXFORD INS.CO.PROVIDER ID
NY0911717OtherAETNA PROVIDER ID
NYV7W441Medicare ID - Type Unspecified