Provider Demographics
NPI:1386223972
Name:QUINTERO GARCIA, MARISEL (CBHCMS)
Entity Type:Individual
Prefix:
First Name:MARISEL
Middle Name:
Last Name:QUINTERO GARCIA
Suffix:
Gender:F
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6110 OAK CLUSTER CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-2343
Mailing Address - Country:US
Mailing Address - Phone:813-531-0852
Mailing Address - Fax:
Practice Address - Street 1:5225 EHRLICH RD STE E
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2066
Practice Address - Country:US
Practice Address - Phone:786-227-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCBHCMS100933104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker