Provider Demographics
NPI:1619297660
Name:MARVINLEIBOWITZ, PH.D., LLC
Entity Type:Organization
Organization Name:MARVINLEIBOWITZ, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:MARVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEIBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:201-445-6378
Mailing Address - Street 1:61 N MAPLE AVE
Mailing Address - Street 2:101
Mailing Address - City:RIDGEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07450-3255
Mailing Address - Country:US
Mailing Address - Phone:201-445-6378
Mailing Address - Fax:201-445-3300
Practice Address - Street 1:61 N MAPLE AVE
Practice Address - Street 2:101
Practice Address - City:RIDGEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07450-3255
Practice Address - Country:US
Practice Address - Phone:201-445-6378
Practice Address - Fax:201-445-3300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100088200103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty