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General NPI Number Information
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NPI Number | 1134561954
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Entity Type | Individual
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Provider Name | MARLEINE FLAURESTALE MA
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Gender | Female
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 04/15/2025
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Provider Practice Location Address
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Address Line | 5768 S SEMORAN BLVD
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City | ORLANDO
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State | FL
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Zip | 32822-4818
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Country | US
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Telephone | 689-204-3361
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Fax |
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Provider Business Mailing Address
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Address Line | 210 PIONEER WAY
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City | ROYAL PALM BEACH
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State | FL
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Zip | 33411-6237
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Country | US
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Telephone | 561-352-6503
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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 | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number | 1134561954
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 23914
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License Number State | FL
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