Healthcare Provider Details

I. General information

NPI: 1033031240
Provider Name (Legal Business Name): MARSOLAIRE BLACKWOOD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARSY BLACKWOOD

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5032 SW 87TH TER
COOPER CITY FL
33328-4334
US

IV. Provider business mailing address

5400 S UNIVERSITY DR
DAVIE FL
33328-5312
US

V. Phone/Fax

Practice location:
  • Phone: 954-802-0204
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH24073
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: