Provider Demographics
NPI:1316067291
Name:BABITS, MARTY (LCSW, BCD)
Entity type:Individual
Prefix:MR
First Name:MARTY
Middle Name:
Last Name:BABITS
Suffix:
Gender:M
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MALCOLM X BLVD
Mailing Address - Street 2:APT 319
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2503
Mailing Address - Country:US
Mailing Address - Phone:212-665-5995
Mailing Address - Fax:
Practice Address - Street 1:170 W END AVE
Practice Address - Street 2:SUITE 1K
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-5401
Practice Address - Country:US
Practice Address - Phone:212-665-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR039973-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP888240OtherOXFORD ID #
NYN4M461Medicare ID - Type Unspecified