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General NPI Number Information
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NPI Number | 1083125934
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Entity Type | Individual
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Provider Name | WANDALIZ MARRERO
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Gender | Female
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Dates
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Enumeration Date | 10/18/2017
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 5535 GRAND BLVD STE A
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-3843
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Country | US
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Telephone | 352-269-5598
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Fax | 813-618-5022
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Provider Business Mailing Address
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Address Line | 4698 MARINER BLVD
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City | SPRING HILL
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State | FL
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Zip | 34609-1945
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Country | US
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Telephone | 484-258-4553
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | MH20078
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License Number State | FL
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