Provider Demographics
NPI:1982328845
Name:NEWBORN, MARLA J
Entity Type:Individual
Prefix:
First Name:MARLA
Middle Name:J
Last Name:NEWBORN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 ROSELLE AVE APT B
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2729
Mailing Address - Country:US
Mailing Address - Phone:917-750-7326
Mailing Address - Fax:
Practice Address - Street 1:33 ROSELLE AVE APT B
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2729
Practice Address - Country:US
Practice Address - Phone:917-750-7326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109992104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker