Provider Demographics
NPI:1114682861
Name:MARRIOTT, COSMORE GODFREY (LPC)
Entity Type:Individual
Prefix:
First Name:COSMORE
Middle Name:GODFREY
Last Name:MARRIOTT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 E SUNRISE BLVD UNIT 508
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2850
Mailing Address - Country:US
Mailing Address - Phone:202-321-9152
Mailing Address - Fax:
Practice Address - Street 1:1015 E SUNRISE BLVD UNIT 508
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-2850
Practice Address - Country:US
Practice Address - Phone:202-321-9152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPRC1482101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty