Provider Demographics
NPI:1467513481
Name:MAROBANLCSW PC
Entity Type:Organization
Organization Name:MAROBANLCSW PC
Other - Org Name:MARBOBANCSW PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CORPORATE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:MITCHEL
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:212-367-3798
Mailing Address - Street 1:85 5TH AVENUE
Mailing Address - Street 2:SUITE 903
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3019
Mailing Address - Country:US
Mailing Address - Phone:212-367-3798
Mailing Address - Fax:718-935-9565
Practice Address - Street 1:85 5TH AVENUE
Practice Address - Street 2:SUITE 903
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3019
Practice Address - Country:US
Practice Address - Phone:212-367-3798
Practice Address - Fax:718-935-9565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN3W421Medicare ID - Type Unspecified