Provider Demographics
NPI:1710453451
Name:BARBACH, MALGORZATA LIDIA (LCSW-R)
Entity Type:Individual
Prefix:
First Name:MALGORZATA
Middle Name:LIDIA
Last Name:BARBACH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 REDWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SMITHTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11787-2718
Mailing Address - Country:US
Mailing Address - Phone:631-331-2176
Mailing Address - Fax:631-792-8311
Practice Address - Street 1:21 REDWOOD LN
Practice Address - Street 2:
Practice Address - City:SMITHTOWN
Practice Address - State:NY
Practice Address - Zip Code:11787-2718
Practice Address - Country:US
Practice Address - Phone:631-331-2176
Practice Address - Fax:631-792-8311
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-20
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0869841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical