Healthcare Provider Details

I. General information

NPI: 1275440943
Provider Name (Legal Business Name): ITAYARA GOMES MARINHO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2026
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NW 67TH ST APT 101
BOCA RATON FL
33487-2942
US

IV. Provider business mailing address

340 NW 67TH ST APT 101
BOCA RATON FL
33487-2942
US

V. Phone/Fax

Practice location:
  • Phone: 305-608-9055
  • Fax:
Mailing address:
  • Phone: 305-608-9055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT5496
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: