Provider Demographics
NPI:1609025626
Name:MARILYN J VARCOE PHD LLC
Entity Type:Organization
Organization Name:MARILYN J VARCOE PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:J
Authorized Official - Last Name:VARCOE
Authorized Official - Suffix:
Authorized Official - Credentials:PH D
Authorized Official - Phone:239-263-0966
Mailing Address - Street 1:5150 TAMIAMI TRL N
Mailing Address - Street 2:STE 203
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-2812
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5150 TAMIAMI TRL N
Practice Address - Street 2:STE 203
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-2812
Practice Address - Country:US
Practice Address - Phone:239-263-0966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-15
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
54562Medicare UPIN