Provider Demographics
NPI:1619688314
Name:HEALTH AND HEALING MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:HEALTH AND HEALING MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:EGUSQUIZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-210-5277
Mailing Address - Street 1:1599 SE LENNARD RD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-6542
Mailing Address - Country:US
Mailing Address - Phone:772-323-0762
Mailing Address - Fax:
Practice Address - Street 1:1599 SE LENNARD RD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-6542
Practice Address - Country:US
Practice Address - Phone:772-323-0762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty