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General NPI Number Information
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NPI Number | 1922168210
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Entity Type | Individual
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Provider Name | BOZENA TERESA MARCINCZYK PH.D.,LMFT
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Gender | Female
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Dates
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Enumeration Date | 12/09/2006
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | 5727 ILLUMINATION LN
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City | LEESBURG
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State | FL
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Zip | 34748-8398
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Country | US
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Telephone | 352-314-2296
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Fax | 352-314-2296
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Provider Business Mailing Address
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Address Line | 5727 ILLUMINATION LN
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City | LEESBURG
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State | FL
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Zip | 34748-8398
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Country | US
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Telephone | 352-314-2296
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Fax | 352-314-2296
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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 | LF00001238
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License Number State | WA
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