Provider Demographics
NPI:1568243475
Name:BOAN VALENTIN, MARLON
Entity Type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:BOAN VALENTIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4851 PARKCREST ST
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33415-8503
Mailing Address - Country:US
Mailing Address - Phone:561-460-9302
Mailing Address - Fax:
Practice Address - Street 1:12300 S SHORE BLVD STE 222
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6509
Practice Address - Country:US
Practice Address - Phone:561-420-3810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-09
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-302548106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician