Provider Demographics
NPI:1184859696
Name:NORMAN, MARCIA TILSON (PSYD)
Entity Type:Individual
Prefix:
First Name:MARCIA
Middle Name:TILSON
Last Name:NORMAN
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 1:870 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-9270
Mailing Address - Country:US
Mailing Address - Phone:407-760-6616
Mailing Address - Fax:
Practice Address - Street 1:6778 FERNRIDGE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-2745
Practice Address - Country:US
Practice Address - Phone:407-760-6616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-28
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7907103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCE341YMedicare PIN