Provider Demographics
NPI:1467868323
Name:GOULART, MARLENE DUPUIS
Entity Type:Individual
Prefix:MS
First Name:MARLENE
Middle Name:DUPUIS
Last Name:GOULART
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 1:245 15TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4701
Mailing Address - Country:US
Mailing Address - Phone:727-773-7547
Mailing Address - Fax:
Practice Address - Street 1:13220 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-1107
Practice Address - Country:US
Practice Address - Phone:813-891-9474
Practice Address - Fax:813-891-9058
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor