Provider Demographics
NPI:1447294988
Name:MARBAN, ELSA M (LMHC PSY D)
Entity type:Individual
Prefix:
First Name:ELSA
Middle Name:M
Last Name:MARBAN
Suffix:
Gender:F
Credentials:LMHC PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2264 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33135-3112
Mailing Address - Country:US
Mailing Address - Phone:305-631-0778
Mailing Address - Fax:305-631-0779
Practice Address - Street 1:2264 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33135-3112
Practice Address - Country:US
Practice Address - Phone:305-631-0778
Practice Address - Fax:305-613-0779
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 6114103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3990AMedicare ID - Type Unspecified