Provider Demographics
NPI:1205238144
Name:MARQUITH, KIRA JOANN (MS)
Entity type:Individual
Prefix:
First Name:KIRA
Middle Name:JOANN
Last Name:MARQUITH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3505 PROGRESS LN
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:FL
Mailing Address - Zip Code:34769-6519
Mailing Address - Country:US
Mailing Address - Phone:407-891-8044
Mailing Address - Fax:407-891-7819
Practice Address - Street 1:3505 PROGRESS LN
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-6519
Practice Address - Country:US
Practice Address - Phone:407-891-8044
Practice Address - Fax:407-891-7819
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT2912106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist