Provider Demographics
NPI:1578635777
Name:NOBLE, MYRNA M (LCSW)
Entity Type:Individual
Prefix:
First Name:MYRNA
Middle Name:M
Last Name:NOBLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 SAMPSON AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10465-2912
Mailing Address - Country:US
Mailing Address - Phone:914-426-8857
Mailing Address - Fax:
Practice Address - Street 1:4123 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-6222
Practice Address - Country:US
Practice Address - Phone:718-299-3045
Practice Address - Fax:718-716-2604
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY065924104100000X
NY0756181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY136167177OtherFIDELIS NUMBER