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General NPI Number Information
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NPI Number | 1164034559
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Entity Type | Individual
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Provider Name | MARTINIQUE M MORON RCSWI
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Gender | Female
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Dates
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Enumeration Date | 08/18/2020
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Last Update Date | 08/18/2020
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Provider Practice Location Address
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Address Line | 4244 CENTRAL AVE
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City | SAINT PETERSBURG
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State | FL
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Zip | 33711-1140
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Country | US
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Telephone | 727-346-8306
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Fax |
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Provider Business Mailing Address
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Address Line | 8620 ANGLERS POINTE DR # 2
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City | TEMPLE TERRACE
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State | FL
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Zip | 33637-1844
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Country | US
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Telephone | 850-653-5222
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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 |
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License Number State |
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