Provider Demographics
NPI:1912530544
Name:MACEDO PAPA, MARLENE TEREZINHA
Entity Type:Individual
Prefix:
First Name:MARLENE
Middle Name:TEREZINHA
Last Name:MACEDO PAPA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3908 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-7314
Mailing Address - Country:US
Mailing Address - Phone:754-244-8851
Mailing Address - Fax:
Practice Address - Street 1:3908 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-7314
Practice Address - Country:US
Practice Address - Phone:754-244-8851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-21
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty