Healthcare Provider Details

I. General information

NPI: 1508153701
Provider Name (Legal Business Name): MARILYN PRCIC BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MARILYN MCGREW

II. Dates (important events)

Enumeration Date: 07/08/2011
Last Update Date: 06/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17815 HUNTING BOW CIR
LUTZ FL
33558-5401
US

IV. Provider business mailing address

175 MIDDLE STREET SUITE 1201
LAKE MARY FL
32746
US

V. Phone/Fax

Practice location:
  • Phone: 866-610-0580
  • Fax:
Mailing address:
  • Phone: 866-610-0580
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-11-8563
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: