Provider Demographics
NPI:1821679713
Name:SHUMWAY, MARLO (IMH)
Entity Type:Individual
Prefix:MRS
First Name:MARLO
Middle Name:
Last Name:SHUMWAY
Suffix:
Gender:F
Credentials:IMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7600 SW 57TH AVE STE 302A
Mailing Address - Street 2:
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5427
Mailing Address - Country:US
Mailing Address - Phone:214-454-3700
Mailing Address - Fax:
Practice Address - Street 1:7600 SW 57TH AVE STE 302A
Practice Address - Street 2:
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5427
Practice Address - Country:US
Practice Address - Phone:214-454-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH19747101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health