Provider Demographics
NPI:1841635778
Name:SANTOS, MARINA (MFT)
Entity type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:SANTOS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4561 SW 155TH PL
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4282
Mailing Address - Country:US
Mailing Address - Phone:305-773-3335
Mailing Address - Fax:
Practice Address - Street 1:8180 NW 36TH ST STE 100C
Practice Address - Street 2:
Practice Address - City:DORAL
Practice Address - State:FL
Practice Address - Zip Code:33166-6650
Practice Address - Country:US
Practice Address - Phone:305-773-3335
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT 2862106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist