=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922934769
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARISA FRANCES GILLERAN LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/19/2026
-----------------------------------------------------
Last Update Date | 06/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7740 W LAKE DR
-----------------------------------------------------
City | LAKE CLARKE SHORES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33406-8742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-853-8135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7740 W LAKE DR
-----------------------------------------------------
City | LAKE CLARKE SHORES
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33406-8742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 561-853-8135
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW25668
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------