Provider Demographics
NPI:1083735575
Name:AZARET, MARISA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARISA
Middle Name:
Last Name:AZARET
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2519 GALIANO ST
Mailing Address - Street 2:SUITE 712
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-6132
Mailing Address - Country:US
Mailing Address - Phone:305-446-7673
Mailing Address - Fax:
Practice Address - Street 1:2519 GALIANO ST
Practice Address - Street 2:SUITE 712
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-6132
Practice Address - Country:US
Practice Address - Phone:305-446-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY3799103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical