Provider Demographics
NPI:1750375044
Name:BRIBITZER, MARJORIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:
Last Name:BRIBITZER
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 1:1 HAMPSTEAD VILLAGE
Mailing Address - Street 2:GROWING PAINS PA
Mailing Address - City:HAMPSTEAD
Mailing Address - State:NC
Mailing Address - Zip Code:28443-8319
Mailing Address - Country:US
Mailing Address - Phone:901-270-3811
Mailing Address - Fax:
Practice Address - Street 1:1 HAMPSTEAD VILLAGE
Practice Address - Street 2:GROWING PAINS PA
Practice Address - City:HAMPSTEAD
Practice Address - State:NC
Practice Address - Zip Code:28443-8319
Practice Address - Country:US
Practice Address - Phone:901-270-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-01
Last Update Date:2008-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0024051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6002033Medicaid
NC18263Medicare UPIN
NC6002033Medicaid
IP292591Medicare UPIN
NC2868735Medicare ID - Type Unspecified