Healthcare Provider Details

I. General information

NPI: 1720267552
Provider Name (Legal Business Name): ELSA M MARBAN LMHC PSY D
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2007
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2264 SW 7TH ST
MIAMI FL
33135-3112
US

IV. Provider business mailing address

2264 SW 7TH ST
MIAMI FL
33135-3112
US

V. Phone/Fax

Practice location:
  • Phone: 305-631-0778
  • Fax: 305-631-0779
Mailing address:
  • Phone: 305-631-0778
  • Fax: 305-631-0779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberPY6114
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPY6114
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY6114
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License NumberPY6114
License Number StateFL
# 5
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMH4305
License Number StateFL

VIII. Authorized Official

Name: DR. ELSA MARIA MARBAN
Title or Position: OWNER/ PSYCHOLOGIST
Credential: L.M.H.C., PSY. D.
Phone: 305-631-0778