Healthcare Provider Details

I. General information

NPI: 1548726102
Provider Name (Legal Business Name): MARISA DESTEFANO HUFF MS, LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 03/17/2023
Certification Date: 03/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1555 PALM BEACH LAKES BLVD STE 1560
WEST PALM BEACH FL
33401-2335
US

IV. Provider business mailing address

4100 PLUM TREE LN
RIVIERA BEACH FL
33410-1905
US

V. Phone/Fax

Practice location:
  • Phone: 561-907-4409
  • Fax:
Mailing address:
  • Phone: 561-578-1200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH21396
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: