Provider Demographics
NPI:1790901932
Name:SABUGO-MARROU, NYDIA LISSETTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:NYDIA
Middle Name:LISSETTE
Last Name:SABUGO-MARROU
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 1:3901 S FLAGLER DR APT 501
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33405-2398
Mailing Address - Country:US
Mailing Address - Phone:561-779-6826
Mailing Address - Fax:561-433-3651
Practice Address - Street 1:2324 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33406-7669
Practice Address - Country:US
Practice Address - Phone:561-779-6826
Practice Address - Fax:561-433-3651
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW79981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical