Provider Demographics
NPI:1508003369
Name:ADAM, MARCHELEY (PHD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:MARCHELEY
Middle Name:
Last Name:ADAM
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13241 NW 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33167-1326
Mailing Address - Country:US
Mailing Address - Phone:305-687-9428
Mailing Address - Fax:
Practice Address - Street 1:8323 NW 12TH ST STE 108
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33126-1839
Practice Address - Country:US
Practice Address - Phone:305-400-8511
Practice Address - Fax:305-392-0184
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-15
Last Update Date:2023-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW108891041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111355900Medicaid