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General NPI Number Information
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NPI Number | 1073950887
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Entity Type | Individual
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Provider Name | MARY LANE MARRERO LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/03/2013
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Last Update Date | 02/22/2025
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Provider Practice Location Address
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Address Line | 297 E HIGHWAY 50 STE 1
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City | CLERMONT
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State | FL
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Zip | 34711-2500
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Country | US
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Telephone | 352-404-6589
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Fax |
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Provider Business Mailing Address
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Address Line | 3489 YARIAN DR
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City | HAINES CITY
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State | FL
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Zip | 33844-6656
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Country | US
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Telephone | 850-566-5602
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW10511
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License Number State | FL
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