Provider Demographics
NPI:1053069401
Name:WILMOT, MARLENE ANDREIA (MA)
Entity Type:Individual
Prefix:MRS
First Name:MARLENE
Middle Name:ANDREIA
Last Name:WILMOT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:MARLENE
Other - Middle Name:ANDREIA
Other - Last Name:SINCLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5565 GATLIN AVE APT E
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-7740
Mailing Address - Country:US
Mailing Address - Phone:321-371-1216
Mailing Address - Fax:
Practice Address - Street 1:5565 GATLIN AVE APT E
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-7740
Practice Address - Country:US
Practice Address - Phone:321-371-1216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH22351101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health