Provider Demographics
NPI:1932725918
Name:MARENGO, STEPHEN (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:MARENGO
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10840 N US HIGHWAY 301
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:FL
Mailing Address - Zip Code:34484-3558
Mailing Address - Country:US
Mailing Address - Phone:352-445-1200
Mailing Address - Fax:
Practice Address - Street 1:10840 N US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:FL
Practice Address - Zip Code:34484-3558
Practice Address - Country:US
Practice Address - Phone:352-445-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-24
Last Update Date:2020-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3328106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist