Provider Demographics
NPI:1417070301
Name:MASHBERG, MICHAEL MASHBERG (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:MASHBERG
Last Name:MASHBERG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 CABRINI BLVD
Mailing Address - Street 2:APARTMENT 138
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-1137
Mailing Address - Country:US
Mailing Address - Phone:646-281-5314
Mailing Address - Fax:
Practice Address - Street 1:25 E 10TH ST APT 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-6108
Practice Address - Country:US
Practice Address - Phone:646-281-5314
Practice Address - Fax:212-954-5598
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072378-PR1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
190122000057OtherFIDELIS
MEDICAREOtherA300200191
A300200191OtherMEDICARE
9305158OtherAETNA
NY01994210Medicaid
NY754455OtherBEACON
754455OtherBEACON