Provider Demographics
NPI:1437843406
Name:LOUIS, MARY LOUISINA
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:LOUISINA
Last Name:LOUIS
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 1:814 NW 13TH AVE # A
Mailing Address - Street 2:
Mailing Address - City:DANIA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33004-2353
Mailing Address - Country:US
Mailing Address - Phone:954-274-3194
Mailing Address - Fax:
Practice Address - Street 1:814 NW 13TH AVE # A
Practice Address - Street 2:
Practice Address - City:DANIA BEACH
Practice Address - State:FL
Practice Address - Zip Code:33004-2353
Practice Address - Country:US
Practice Address - Phone:954-274-3194
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-05
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician