MEDICARE: MARIELY FERNANDEZ ROBLES

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1770344392
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIELY FERNANDEZ ROBLES

Provider Business Mailing Address
First Line	:	4617 EGG HARBOR DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-2011
Country	:	US
Telephone Number	:	787-236-6228
Fax Number	:

Provider Business Practice Location Address
First Line	:	4617 EGG HARBOR DR
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34746-2011
Country	:	US
Telephone Number	:	787-236-6228
Fax Number	:

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

Provider Enumeration Date	:	01/22/2024
Last Update Date	:	01/22/2024

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Directions to “ MARIELY FERNANDEZ ROBLES ” Practice Location

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