Healthcare Provider Details

I. General information

NPI: 1851990410
Provider Name (Legal Business Name): GERTRUDIS ALEJANDRA MARRERO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 07/13/2023
Certification Date: 07/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1417 PARTIN DR N STE 1
NICEVILLE FL
32578-1426
US

IV. Provider business mailing address

1417 PARTIN DR N STE 1
NICEVILLE FL
32578-1426
US

V. Phone/Fax

Practice location:
  • Phone: 850-729-0303
  • Fax: 850-729-0305
Mailing address:
  • Phone: 850-729-0303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberSW21625
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: