Provider Demographics
NPI:1124500244
Name:BIRNBERG, BRUCE ADAM (MSW, LMSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:BRUCE
Middle Name:ADAM
Last Name:BIRNBERG
Suffix:
Gender:M
Credentials:MSW, LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W END AVE
Mailing Address - Street 2:APT 8K
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4808
Mailing Address - Country:US
Mailing Address - Phone:732-991-6298
Mailing Address - Fax:
Practice Address - Street 1:24 N 3RD AVE STE 111C
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:NJ
Practice Address - Zip Code:08904-2429
Practice Address - Country:US
Practice Address - Phone:732-991-6298
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-05
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0362681041C0700X
NJ44SC002873001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical