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General NPI Number Information
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NPI Number | 1164638128
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Entity Type | Individual
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Provider Name | MARILYN MARIE VERBISCER M.S., L.M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 05/15/2007
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Last Update Date | 03/28/2017
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Provider Practice Location Address
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Address Line | 8726 FOREST GLEN CT
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City | SAINT JOHN
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State | IN
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Zip | 46373-8795
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Country | US
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Telephone | 219-789-0417
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Fax |
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Provider Business Mailing Address
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Address Line | 8726 FOREST GLEN CT
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City | SAINT JOHN
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State | IN
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Zip | 46373-8795
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Country | US
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Telephone | 219-789-0417
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 35001596A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 166.000792
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License Number State | IL
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