MEDICARE: MARIE VISALLI

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1629122247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE VISALLI

Provider Business Mailing Address
First Line	:	2700 W CYPRESS CREEK RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1744
Country	:	US
Telephone Number	:	954-514-7569
Fax Number	:

Provider Business Practice Location Address
First Line	:	2700 W CYPRESS CREEK RD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1744
Country	:	US
Telephone Number	:	954-514-7569
Fax Number	:	954-514-7569

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	02/24/2024

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Directions to “ MARIE VISALLI ” Practice Location

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