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NPI Code Detail

MEDICARE: DR. MARCKDALINE ST. FORT LCSW, PHD

MEDICARE: DR. MARCKDALINE ST. FORT LCSW, PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist
2104100000XSocial Worker

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518290527
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARCKDALINE ST. FORT LCSW, PHD
Provider Business Mailing Address
First Line : 2054 VISTA PKWY STE 400
Second Line :
City : WEST PALM BEACH
State : FL
Zip : 33411-6742
Country : US
Telephone Number : 561-579-1099
Fax Number :
Provider Business Practice Location Address
First Line : 2950 CLEVELAND CLINIC BLVD
Second Line :
City : WESTON
State : FL
Zip : 33331-3609
Country : US
Telephone Number : 954-649-2807
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2009
Last Update Date : 03/04/2026

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Directions to “ DR. MARCKDALINE ST. FORT LCSW, PHD” Practice Location

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