Provider Demographics
NPI:1720267552
Name:ELSA M MARBAN LMHC PSY D
Entity Type:Organization
Organization Name:ELSA M MARBAN LMHC PSY D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELSA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:MARBAN
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, PSY D
Authorized Official - Phone:305-631-0778
Mailing Address - Street 1:2264 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3112
Mailing Address - Country:US
Mailing Address - Phone:305-631-0778
Mailing Address - Fax:305-631-0779
Practice Address - Street 1:2264 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3112
Practice Address - Country:US
Practice Address - Phone:305-631-0778
Practice Address - Fax:305-631-0779
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ELSA M MARBAN LMHC PSY D
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-29
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6114101YA0400X, 103TA0400X, 103TC0700X, 103TR0400X
FLMH4305106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Single Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Single Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3990AMedicare UPIN