Healthcare Provider Details

I. General information

NPI: 1518982271
Provider Name (Legal Business Name): MARSHA NICOLE TARDIVO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARSHA NICOLE GALLO

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1890 N UNIVERSITY DR SUITE 215
CORAL SPRINGS FL
33071-8963
US

IV. Provider business mailing address

4669 ISLAND REEF DR
WELLINGTON FL
33467-8398
US

V. Phone/Fax

Practice location:
  • Phone: 954-277-2700
  • Fax: 954-277-2704
Mailing address:
  • Phone: 561-452-0304
  • Fax: 561-204-4177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7709
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: