Provider Demographics
NPI:1619418357
Name:INCIARTE, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:INCIARTE
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 1:10227 FALCON PARC BLVD APT 201
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832-5522
Mailing Address - Country:US
Mailing Address - Phone:407-473-1452
Mailing Address - Fax:
Practice Address - Street 1:10227 FALCON PARC BLVD APT 201
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-5522
Practice Address - Country:US
Practice Address - Phone:407-473-1452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-14
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator