Provider Demographics
NPI:1114264645
Name:DOTTS, MARISA R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARISA
Middle Name:R
Last Name:DOTTS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 S AUSTRALIAN AVE
Mailing Address - Street 2:STE 600 # 1152
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:718-207-4566
Mailing Address - Fax:
Practice Address - Street 1:500 S AUSTRALIAN AVE
Practice Address - Street 2:STE 600 # 1152
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:718-207-4566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-03
Last Update Date:2024-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0801431041C0700X
WALW614776621041C0700X
FLSW211121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical