Healthcare Provider Details

I. General information

NPI: 1114914686
Provider Name (Legal Business Name): MARLA J EDELBERG MSW, ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARLA EDELBERG MSW

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82-26 262ND STREET
FLORAL PARK NY
11004
US

IV. Provider business mailing address

8226 262ND ST
FLORAL PARK NY
11004-1513
US

V. Phone/Fax

Practice location:
  • Phone: 718-347-0360
  • Fax: 718-347-0360
Mailing address:
  • Phone: 718-347-0360
  • Fax: 718-347-0360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL220511
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR#22051-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: