Provider Demographics
NPI:1184926321
Name:ROSHAL, MARINA (LMSW)
Entity type:Individual
Prefix:MS
First Name:MARINA
Middle Name:
Last Name:ROSHAL
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 WINTHROP PL
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314-3043
Mailing Address - Country:US
Mailing Address - Phone:718-816-6760
Mailing Address - Fax:718-667-3260
Practice Address - Street 1:38 WINTHROP PL
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10314-3043
Practice Address - Country:US
Practice Address - Phone:718-816-6760
Practice Address - Fax:718-667-3260
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-19
Last Update Date:2010-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081658-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker