Provider Demographics
NPI:1609976398
Name:MARMOR, GLORIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:
Last Name:MARMOR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 RIDGEWAY RD
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11050-2729
Mailing Address - Country:US
Mailing Address - Phone:516-883-3166
Mailing Address - Fax:516-883-5262
Practice Address - Street 1:13 RIDGEWAY RD
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:NY
Practice Address - Zip Code:11050-2729
Practice Address - Country:US
Practice Address - Phone:516-883-3166
Practice Address - Fax:516-883-5262
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007354-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV22212Medicare ID - Type Unspecified