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General NPI Number Information
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NPI Number | 1689974222
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Entity Type | Organization
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Legal Business Name | MARIANNE C.MCAULIFFE,LCSW,PL
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Dates
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Enumeration Date | 10/29/2010
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Last Update Date | 10/29/2010
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Provider Practice Location Address
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Address Line | 403 HOLLYWOOD BLVD NW SUITE 104A
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4502
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Country | US
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Telephone | 850-244-0101
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Fax |
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Provider Business Mailing Address
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Address Line | 403 HOLLYWOOD BLVD NW SUITE 104A
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-4502
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Country | US
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Telephone | 850-244-0101
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARIANNE C MCAULIFFE
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Credential | LCSW
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Telephone | 850-244-0101
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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 | 2519
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License Number State | FL
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