Provider Demographics
NPI:1427582949
Name:MARIKA, JOHN (CAP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MARIKA
Suffix:
Gender:M
Credentials:CAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 BAYSIDE LN
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-3340
Mailing Address - Country:US
Mailing Address - Phone:954-253-4958
Mailing Address - Fax:
Practice Address - Street 1:830 BAYSIDE LN
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-3340
Practice Address - Country:US
Practice Address - Phone:954-253-4958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLADC-001642-2014103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)