Provider Demographics
NPI:1598134371
Name:BARBAGIOVANNI, MARK PORTNOY (LMSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:PORTNOY
Last Name:BARBAGIOVANNI
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 DAYTON LN STE 205
Mailing Address - Street 2:
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2860
Mailing Address - Country:US
Mailing Address - Phone:914-736-3371
Mailing Address - Fax:914-736-3372
Practice Address - Street 1:50 DAYTON LN STE 205
Practice Address - Street 2:
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2860
Practice Address - Country:US
Practice Address - Phone:914-736-3371
Practice Address - Fax:914-736-3372
Is Sole Proprietor?:No
Enumeration Date:2015-09-22
Last Update Date:2018-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0993911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical