Provider Demographics
NPI:1922361252
Name:MARLENE J. BATAVIA, P.A.
Entity Type:Organization
Organization Name:MARLENE J. BATAVIA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARLENE
Authorized Official - Middle Name:J
Authorized Official - Last Name:BATAVIA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:561-496-6400
Mailing Address - Street 1:7610 GLENDEVON LN
Mailing Address - Street 2:
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33446-2805
Mailing Address - Country:US
Mailing Address - Phone:561-496-6400
Mailing Address - Fax:561-637-6226
Practice Address - Street 1:7610 GLENDEVON LN
Practice Address - Street 2:5210 LINTON BLVD
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33446-2805
Practice Address - Country:US
Practice Address - Phone:561-496-6400
Practice Address - Fax:561-637-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-21
Last Update Date:2012-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW2681261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ3950Medicare PIN