Provider Demographics
NPI:1144330226
Name:DENBURG, MARVIN LAWRENCE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:LAWRENCE
Last Name:DENBURG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2101 ACT CIRCLE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52245
Mailing Address - Country:US
Mailing Address - Phone:319-337-6483
Mailing Address - Fax:319-337-4208
Practice Address - Street 1:2101 ACT CIRCLE
Practice Address - Street 2:SUITE 202
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52245
Practice Address - Country:US
Practice Address - Phone:319-337-6483
Practice Address - Fax:319-337-4208
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5281-0103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01625209Medicaid
NY01625209Medicaid