Provider Demographics
NPI:1073221115
Name:MARRERO, MERLYS
Entity Type:Individual
Prefix:
First Name:MERLYS
Middle Name:
Last Name:MARRERO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 SW 53RD ST APT 1
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33314-6514
Mailing Address - Country:US
Mailing Address - Phone:786-282-8074
Mailing Address - Fax:
Practice Address - Street 1:4200 SW 53RD ST APT 1
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-6514
Practice Address - Country:US
Practice Address - Phone:786-282-8074
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-08
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician