Provider Demographics
NPI:1295540581
Name:MAROM, MICHELLE (LSW)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:MAROM
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N SUMMIT ST
Mailing Address - Street 2:
Mailing Address - City:TENAFLY
Mailing Address - State:NJ
Mailing Address - Zip Code:07670-1036
Mailing Address - Country:US
Mailing Address - Phone:917-648-5571
Mailing Address - Fax:
Practice Address - Street 1:101 N SUMMIT ST
Practice Address - Street 2:
Practice Address - City:TENAFLY
Practice Address - State:NJ
Practice Address - Zip Code:07670-1036
Practice Address - Country:US
Practice Address - Phone:201-564-7331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05500000104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker