Provider Demographics
NPI:1053607788
Name:LIFF, MARC BRUCE (LMSW)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:BRUCE
Last Name:LIFF
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2470 W 1ST ST APT 2H
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-5957
Mailing Address - Country:US
Mailing Address - Phone:718-645-3508
Mailing Address - Fax:
Practice Address - Street 1:198 FOSTER AVE
Practice Address - Street 2:SUITE D
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-2133
Practice Address - Country:US
Practice Address - Phone:718-666-1009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72-082601104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker