Provider Demographics
NPI:1386229193
Name:MARQUEZ, CARLOS T (CBHCM)
Entity Type:Individual
Prefix:
First Name:CARLOS
Middle Name:T
Last Name:MARQUEZ
Suffix:
Gender:M
Credentials:CBHCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14240 SW 47TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-4320
Mailing Address - Country:US
Mailing Address - Phone:786-234-4979
Mailing Address - Fax:
Practice Address - Street 1:3600 S STATE ROAD 7 STE 252
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-7207
Practice Address - Country:US
Practice Address - Phone:195-450-5374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker