Provider Demographics
NPI:1538306048
Name:MB CLINICIANS
Entity Type:Organization
Organization Name:MB CLINICIANS
Other - Org Name:ROBINSON, MASS AND BURRELL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BURRELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:646-442-3925
Mailing Address - Street 1:75 MAIDEN LANE
Mailing Address - Street 2:SUITE 216
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038
Mailing Address - Country:US
Mailing Address - Phone:646-442-3925
Mailing Address - Fax:646-442-3924
Practice Address - Street 1:75 MAIDEN LN
Practice Address - Street 2:SUITE 216
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4810
Practice Address - Country:US
Practice Address - Phone:646-442-3925
Practice Address - Fax:646-442-3924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-21
Last Update Date:2009-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055306-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN1U791Medicare UPIN