Provider Demographics
NPI:1780212324
Name:PLOCINIAK, MARIAH M (LMFT)
Entity Type:Individual
Prefix:
First Name:MARIAH
Middle Name:M
Last Name:PLOCINIAK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARIAH
Other - Middle Name:M
Other - Last Name:HETTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:1317 EDGEWATER DR STE 4854
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6350
Mailing Address - Country:US
Mailing Address - Phone:321-413-3482
Mailing Address - Fax:
Practice Address - Street 1:1317 EDGEWATER DR STE 4854
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6350
Practice Address - Country:US
Practice Address - Phone:321-413-3482
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-30
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT4205106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist