Healthcare Provider Details

I. General information

NPI: 1699749846
Provider Name (Legal Business Name): MARIANNE L MCCAIN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 MIRACLE STRIP PKWY SW SUITE 32A
FT WALTON BEACH FL
32548-5200
US

IV. Provider business mailing address

348 MIRACLE STRIP PKWY SW SUITE 32A
FT WALTON BEACH FL
32548-5200
US

V. Phone/Fax

Practice location:
  • Phone: 850-664-7690
  • Fax: 850-664-7691
Mailing address:
  • Phone: 850-664-7690
  • Fax: 850-664-7691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY0004162
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: