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General NPI Number Information
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NPI Number | 1619297660
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Entity Type | Organization
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Legal Business Name | MARVINLEIBOWITZ, PH.D., LLC
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 06/01/2010
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Provider Practice Location Address
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Address Line | 61 N MAPLE AVE 101
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3255
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Country | US
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Telephone | 201-445-6378
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Fax | 201-445-3300
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Provider Business Mailing Address
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Address Line | 61 N MAPLE AVE 101
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City | RIDGEWOOD
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State | NJ
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Zip | 07450-3255
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Country | US
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Telephone | 201-445-6378
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Fax | 201-445-3300
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Authorized Official
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Title or Position | GENERAL PARTNER
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Name | MARVIN LEIBOWITZ
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Credential | PH.D.
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Telephone | 201-445-6378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35S100088200
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License Number State | NJ
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