Provider Demographics
NPI:1336420926
Name:MARCHESE, MARILYN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:MARCHESE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2268 LAS FUENTES DR
Mailing Address - Street 2:
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-9407
Mailing Address - Country:US
Mailing Address - Phone:407-634-7660
Mailing Address - Fax:
Practice Address - Street 1:2268 LAS FUENTES DR
Practice Address - Street 2:
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-9407
Practice Address - Country:US
Practice Address - Phone:407-634-7660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-08
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8173101YM0800X
FL10101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health