MEDICARE: MS. MARLA J EDELBERG MSW, ACSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	L220511	NY
2	104100000X	Social Worker	R#22051-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P3226225	OTHER	NY	OXFORD
2	0049430	OTHER	NY	VBH

General Provider Information

NPI Number	:	1114914686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARLA J EDELBERG MSW, ACSW

Provider Business Mailing Address
First Line	:	8226 262ND ST
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11004-1513
Country	:	US
Telephone Number	:	718-347-0360
Fax Number	:	718-347-0360

Provider Business Practice Location Address
First Line	:	82-26 262ND STREET
Second Line	:
City	:	FLORAL PARK
State	:	NY
Zip	:	11004
Country	:	US
Telephone Number	:	718-347-0360
Fax Number	:	718-347-0360

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	03/07/2012

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