Healthcare Provider Details

I. General information

NPI: 1851877302
Provider Name (Legal Business Name): MARYLISE ZWARTS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

385 SE CARDINAL TRL
STUART FL
34997-7303
US

IV. Provider business mailing address

385 SE CARDINAL TRL
STUART FL
34997-7303
US

V. Phone/Fax

Practice location:
  • Phone: 772-333-7905
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPMH1581
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: