MEDICARE: MARWICK MORENO

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
1	106S00000X	Behavior Technician	20-138523	FL

Other Identifiers

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

General Provider Information

NPI Number	:	1659034163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARWICK MORENO

Provider Business Mailing Address
First Line	:	5305 W 22ND CT
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2045
Country	:	US
Telephone Number	:	786-760-4691
Fax Number	:

Provider Business Practice Location Address
First Line	:	5305 W 22ND CT
Second Line	:
City	:	HIALEAH GARDENS
State	:	FL
Zip	:	33016-2045
Country	:	US
Telephone Number	:	786-760-4691
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2021
Last Update Date	:	10/21/2021

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Directions to “ MARWICK MORENO ” Practice Location

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