Provider Demographics
NPI:1255197844
Name:LINIEWSKI, MARIELLE
Entity type:Individual
Prefix:
First Name:MARIELLE
Middle Name:
Last Name:LINIEWSKI
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 1:461 PLAZA DR STE C
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-7968
Mailing Address - Country:US
Mailing Address - Phone:727-207-0508
Mailing Address - Fax:
Practice Address - Street 1:461 PLAZA DR STE C
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-7968
Practice Address - Country:US
Practice Address - Phone:727-207-0508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-22
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL24-341769106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician