Provider Demographics
NPI:1285468595
Name:CHITOROGA, MARINA
Entity type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:CHITOROGA
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 1:27911 CROWN LAKE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34135-4218
Mailing Address - Country:US
Mailing Address - Phone:800-681-1403
Mailing Address - Fax:800-681-1403
Practice Address - Street 1:27911 CROWN LAKE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34135-4218
Practice Address - Country:US
Practice Address - Phone:800-681-1403
Practice Address - Fax:800-681-1403
Is Sole Proprietor?:No
Enumeration Date:2024-08-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-372330106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician