Provider Demographics
NPI:1376675165
Name:MARR, ELIZABETH
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:MARR
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 1:5325 GREENWOOD AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2452
Mailing Address - Country:US
Mailing Address - Phone:561-882-6406
Mailing Address - Fax:561-881-0972
Practice Address - Street 1:5325 GREENWOOD AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2452
Practice Address - Country:US
Practice Address - Phone:561-882-6406
Practice Address - Fax:561-881-0972
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
FLSA 3897235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767516000Medicaid
FL889252100Medicaid