Healthcare Provider Details

I. General information

NPI: 1033327226
Provider Name (Legal Business Name): MARINA GRINBERG LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 BRUNSWICK AVE
TRENTON NJ
08638-3829
US

IV. Provider business mailing address

1219 N OAKS BLVD
NORTH BRUNSWICK NJ
08902-2153
US

V. Phone/Fax

Practice location:
  • Phone: 609-396-8877
  • Fax:
Mailing address:
  • Phone: 732-317-3698
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number37PC00353600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: