Healthcare Provider Details

I. General information

NPI: 1598134371
Provider Name (Legal Business Name): MARK PORTNOY BARBAGIOVANNI LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2015
Last Update Date: 10/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 DAYTON LN STE 205
PEEKSKILL NY
10566-2860
US

IV. Provider business mailing address

50 DAYTON LN STE 205
PEEKSKILL NY
10566-2860
US

V. Phone/Fax

Practice location:
  • Phone: 914-736-3371
  • Fax: 914-736-3372
Mailing address:
  • Phone: 914-736-3371
  • Fax: 914-736-3372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number099391
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: