Provider Demographics
NPI:1790831006
Name:CABASSO, MARCIA RENIE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:MARCIA
Middle Name:RENIE
Last Name:CABASSO
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 1:260 E 188TH ST
Mailing Address - Street 2:5TH FLOOR
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-5302
Mailing Address - Country:US
Mailing Address - Phone:718-960-0260
Mailing Address - Fax:718-933-2502
Practice Address - Street 1:260 E 188TH ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-5302
Practice Address - Country:US
Practice Address - Phone:718-960-0260
Practice Address - Fax:718-933-2502
Is Sole Proprietor?:No
Enumeration Date:2007-01-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR036075-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical