Healthcare Provider Details

I. General information

NPI: 1447675467
Provider Name (Legal Business Name): MARISSA EW DANDURAND LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W MICHIGAN ST
ORLANDO FL
32805-6203
US

IV. Provider business mailing address

601 W MICHIGAN ST
ORLANDO FL
32805-6203
US

V. Phone/Fax

Practice location:
  • Phone: 407-317-7430
  • Fax: 407-540-1924
Mailing address:
  • Phone: 407-317-7430
  • Fax: 407-540-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMT3187
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: