Provider Demographics
NPI:1831637685
Name:TRGOVAC, MARIE LOUISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARIE
Middle Name:LOUISE
Last Name:TRGOVAC
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1765 BANYAN DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1609
Mailing Address - Country:US
Mailing Address - Phone:570-490-0620
Mailing Address - Fax:
Practice Address - Street 1:1765 BANYAN DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-1609
Practice Address - Country:US
Practice Address - Phone:570-490-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9611103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical