MEDICARE: MARLENE SILVA-ROSABAL I MFC

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	106H00000X	Marriage & Family Therapist	0965	PR

General Provider Information

NPI Number	:	1568861532
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARLENE SILVA-ROSABAL I MFC

Provider Business Mailing Address
First Line	:	3407 WILSHIRE WAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32829-7353
Country	:	US
Telephone Number	:	787-428-5150
Fax Number	:

Provider Business Practice Location Address
First Line	:	3407 WILSHIRE WAY RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32829-7353
Country	:	US
Telephone Number	:	407-286-4498
Fax Number	:

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

Provider Enumeration Date	:	08/15/2014
Last Update Date	:	08/15/2014

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