Provider Demographics
NPI:1376955567
Name:CSUHRAN, MARCY
Entity Type:Individual
Prefix:
First Name:MARCY
Middle Name:
Last Name:CSUHRAN
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 1:2351 LAKES OF MELBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-9160
Mailing Address - Country:US
Mailing Address - Phone:321-591-6641
Mailing Address - Fax:
Practice Address - Street 1:2351 LAKES OF MELBOURNE DR
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-9160
Practice Address - Country:US
Practice Address - Phone:321-591-6641
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-22
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW12099101YM0800X
222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist