Provider Demographics
NPI:1649240441
Name:MCAULIFFE, MARIANNE C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARIANNE
Middle Name:C
Last Name:MCAULIFFE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 HOLLYWOOD BLVD NW
Mailing Address - Street 2:SUITE104A
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-4502
Mailing Address - Country:US
Mailing Address - Phone:850-244-0101
Mailing Address - Fax:850-243-9795
Practice Address - Street 1:403 HOLLYWOOD BLVD NW
Practice Address - Street 2:SUITE104A
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-4502
Practice Address - Country:US
Practice Address - Phone:850-244-0101
Practice Address - Fax:850-243-9795
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW25191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL089355OtherVALUE OPTIONS NUMBER
FLZ3290OtherBLUECROSS/BLUE SHIELD NUM
FL089355OtherVALUE OPTIONS NUMBER
FL089355OtherVALUE OPTIONS NUMBER