Healthcare Provider Details

I. General information

NPI: 1174168975
Provider Name (Legal Business Name): ELIZABETH SHOMBERG MARCINSKI IMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/15/2019
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2963 GULF TO BAY BLVD STE 320
CLEARWATER FL
33759-4286
US

IV. Provider business mailing address

1389 MILTON ST
CLEARWATER FL
33756-4282
US

V. Phone/Fax

Practice location:
  • Phone: 727-367-2273
  • Fax:
Mailing address:
  • Phone: 727-475-9531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21549
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: