Provider Demographics
NPI:1275076481
Name:MONTERO SAVINON, MARIELISA (LMFT)
Entity Type:Individual
Prefix:
First Name:MARIELISA
Middle Name:
Last Name:MONTERO SAVINON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 EXECUTIVE PARK DR # 200
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33331-3624
Mailing Address - Country:US
Mailing Address - Phone:336-448-8318
Mailing Address - Fax:
Practice Address - Street 1:2645 EXECUTIVE PARK DR # 200
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33331-3624
Practice Address - Country:US
Practice Address - Phone:336-448-8318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-21
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1963106H00000X
TX204722106H00000X
FLMT4370106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist