Provider Demographics
NPI:1689974222
Name:MARIANNE C.MCAULIFFE,LCSW,PL
Entity Type:Organization
Organization Name:MARIANNE C.MCAULIFFE,LCSW,PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:C
Authorized Official - Last Name:MCAULIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:850-244-0101
Mailing Address - Street 1:403 HOLLYWOOD BLVD NW
Mailing Address - Street 2:SUITE 104A
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:
Practice Address - Street 1:403 HOLLYWOOD BLVD NW
Practice Address - Street 2:SUITE 104A
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-29
Last Update Date:2010-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL25191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3290YMedicare PIN