Provider Demographics
NPI:1255078200
Name:LONDONO, MARLEN G
Entity type:Individual
Prefix:
First Name:MARLEN
Middle Name:G
Last Name:LONDONO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 SW 117TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-3915
Mailing Address - Country:US
Mailing Address - Phone:786-334-2432
Mailing Address - Fax:
Practice Address - Street 1:9900 STIRLING RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-8065
Practice Address - Country:US
Practice Address - Phone:954-906-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-19
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health