MEDICARE: MARIE-LOUISE DEFEO PSY.D.

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	103TC0700X	Clinical Psychologist	PY6980	FL

General Provider Information

NPI Number	:	1952588964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIE-LOUISE DEFEO PSY.D.

Provider Business Mailing Address
First Line	:	2851 W PROSPECT RD UNIT 1211
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-2631
Country	:	US
Telephone Number	:	954-529-7910
Fax Number	:	954-301-0852

Provider Business Practice Location Address
First Line	:	2851 W PROSPECT RD UNIT 1211
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-2631
Country	:	US
Telephone Number	:	954-529-7910
Fax Number	:	954-301-0852

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

Provider Enumeration Date	:	01/22/2008
Last Update Date	:	08/18/2020

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