Provider Demographics
NPI:1225292881
Name:STAMM, MARION
Entity Type:Individual
Prefix:
First Name:MARION
Middle Name:
Last Name:STAMM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 N DIXIE HWY
Mailing Address - Street 2:SUITE146
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1850
Mailing Address - Country:US
Mailing Address - Phone:561-750-9710
Mailing Address - Fax:561-750-3959
Practice Address - Street 1:1700 N DIXIE HWY
Practice Address - Street 2:SUITE111
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33432-1850
Practice Address - Country:US
Practice Address - Phone:561-750-9710
Practice Address - Fax:561-750-3959
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00003471104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker