Provider Demographics
NPI:1164638128
Name:VERBISCER, MARILYN MARIE (MS, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:MARILYN
Middle Name:MARIE
Last Name:VERBISCER
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8726 FOREST GLEN CT
Mailing Address - Street 2:
Mailing Address - City:SAINT JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-8795
Mailing Address - Country:US
Mailing Address - Phone:219-789-0417
Mailing Address - Fax:
Practice Address - Street 1:8726 FOREST GLEN CT
Practice Address - Street 2:
Practice Address - City:SAINT JOHN
Practice Address - State:IN
Practice Address - Zip Code:46373-8795
Practice Address - Country:US
Practice Address - Phone:219-789-0417
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001596A106H00000X
IL166.000792106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist