MEDICARE: MARIANITA ALLEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW23867

General Provider Information

NPI Number	:	1164355939
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIANITA ALLEN

Provider Business Mailing Address
First Line	:	3650 PETUNIA TER
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-7599
Country	:	US
Telephone Number	:	941-376-7235
Fax Number	:

Provider Business Practice Location Address
First Line	:	3650 PETUNIA TER
Second Line	:
City	:	NORTH PORT
State	:	FL
Zip	:	34286-7599
Country	:	US
Telephone Number	:	941-376-7235
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2026
Last Update Date	:	06/03/2026

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Directions to “ MARIANITA ALLEN ” Practice Location

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