Provider Demographics
NPI:1609221043
Name:GRAUBARD, MARISOL (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARISOL
Middle Name:
Last Name:GRAUBARD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7410 35TH AVE
Mailing Address - Street 2:SUITE 107 W
Mailing Address - City:JACKSON HEIGHTS
Mailing Address - State:NY
Mailing Address - Zip Code:11372-8197
Mailing Address - Country:US
Mailing Address - Phone:718-672-1538
Mailing Address - Fax:718-429-0713
Practice Address - Street 1:7410 35TH AVE
Practice Address - Street 2:SUITE 107 W
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-8197
Practice Address - Country:US
Practice Address - Phone:718-672-1538
Practice Address - Fax:718-429-0713
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY084266-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical