MEDICARE: MARTA Y DECLET

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	101YM0800X	Mental Health Counselor		FL

General Provider Information

NPI Number	:	1215417035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARTA Y DECLET

Provider Business Mailing Address
First Line	:	10095 DAVIS CREEK CIR APT 4403
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-6456
Country	:	US
Telephone Number	:	787-344-5277
Fax Number	:

Provider Business Practice Location Address
First Line	:	7726 WINEGARD RD STE 53
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32809-7147
Country	:	US
Telephone Number	:	407-329-3464
Fax Number	:

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

Provider Enumeration Date	:	08/21/2018
Last Update Date	:	05/02/2024

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Directions to “ MARTA Y DECLET ” Practice Location

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