Provider Demographics
NPI:1770644197
Name:SALTZBERG, MARJORIE R (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:R
Last Name:SALTZBERG
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W 86TH ST
Mailing Address - Street 2:#1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3421
Mailing Address - Country:US
Mailing Address - Phone:212-769-0370
Mailing Address - Fax:
Practice Address - Street 1:145 W 86TH ST
Practice Address - Street 2:#1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3421
Practice Address - Country:US
Practice Address - Phone:212-769-0370
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR01675111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11634739OtherCAQH PROVIDER ID NUMBER
N25141Medicare ID - Type Unspecified