Provider Demographics
NPI:1346950854
Name:PARKER-LOVELY, MARTIE (MED)
Entity Type:Individual
Prefix:
First Name:MARTIE
Middle Name:
Last Name:PARKER-LOVELY
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9000 CLUBHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3229
Mailing Address - Country:US
Mailing Address - Phone:772-446-7888
Mailing Address - Fax:
Practice Address - Street 1:9000 CLUBHOUSE DR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-3229
Practice Address - Country:US
Practice Address - Phone:772-446-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101YM0800XMedicaid