Provider Demographics
NPI:1518982271
Name:TARDIVO, MARSHA NICOLE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARSHA
Middle Name:NICOLE
Last Name:TARDIVO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARSHA
Other - Middle Name:NICOLE
Other - Last Name:GALLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4669 ISLAND REEF DR
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33467-8398
Mailing Address - Country:US
Mailing Address - Phone:561-452-0304
Mailing Address - Fax:561-204-4177
Practice Address - Street 1:1890 N UNIVERSITY DR
Practice Address - Street 2:SUITE 215
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8963
Practice Address - Country:US
Practice Address - Phone:954-277-2700
Practice Address - Fax:954-277-2704
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW77091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical