Healthcare Provider Details

I. General information

NPI: 1023131968
Provider Name (Legal Business Name): MARSHA L DEAKTER MS,LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2007
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19500 TURNBERRY WAY PH F
AVENTURA FL
33180
US

IV. Provider business mailing address

19500 TURNBERRY WAY PH F
AVENTURA FL
33180-2539
US

V. Phone/Fax

Practice location:
  • Phone: 786-877-5800
  • Fax:
Mailing address:
  • Phone: 305-932-6578
  • Fax: 305-692-1723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH969
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: