Provider Demographics
NPI:1821495490
Name:GARBOSE, MIRIAM (MS)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:GARBOSE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:LIBBY
Other - Middle Name:
Other - Last Name:HERZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:1247 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-1605
Mailing Address - Country:US
Mailing Address - Phone:718-909-5408
Mailing Address - Fax:
Practice Address - Street 1:1247 PRESIDENT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11225-1605
Practice Address - Country:US
Practice Address - Phone:718-909-5408
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY774028085103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst