Provider Demographics
NPI:1568861532
Name:SILVA-ROSABAL, MARLENE I (MFC)
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:
Last Name:SILVA-ROSABAL
Suffix:I
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3407 WILSHIRE WAY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32829-7353
Mailing Address - Country:US
Mailing Address - Phone:787-428-5150
Mailing Address - Fax:
Practice Address - Street 1:3407 WILSHIRE WAY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32829-7353
Practice Address - Country:US
Practice Address - Phone:407-286-4498
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-15
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR0965106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist