Provider Demographics
NPI:1033711023
Name:MADRIGAL, MARIANNE ELIZABETH (BEHAVIOR TECHNICIAN)
Entity Type:Individual
Prefix:MISS
First Name:MARIANNE
Middle Name:ELIZABETH
Last Name:MADRIGAL
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2505 BLACK HORSE LOOP # 16-301
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33559-7730
Mailing Address - Country:US
Mailing Address - Phone:863-447-1449
Mailing Address - Fax:
Practice Address - Street 1:27604 CASHFORD CIR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33544-6952
Practice Address - Country:US
Practice Address - Phone:352-537-4029
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician