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General NPI Number Information
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NPI Number | 1619334141
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Entity Type | Individual
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Provider Name | MARVIN CARGLE MSOL,,MSP
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Gender | Male
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Dates
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Enumeration Date | 01/28/2016
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Last Update Date | 01/28/2016
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Provider Practice Location Address
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Address Line | 538 BROADHOLLOW RD STE 202
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City | MELVILLE
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State | NY
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Zip | 11747-3668
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Country | US
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Telephone | 631-385-7780
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Fax | 631-385-7795
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Provider Business Mailing Address
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Address Line | 356 MOSEBY CT
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City | MANASSAS PARK
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State | VA
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Zip | 20111-2098
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Country | US
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Telephone | 347-866-8511
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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