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NPI Code Detail

MEDICARE: JESSICA SHIRLEY MARDER

MEDICARE:   JESSICA SHIRLEY MARDER
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1992097976
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA SHIRLEY MARDER
Provider Business Mailing Address
First Line : 4887 NEW BROAD ST
Second Line : APT 2013
City : ORLANDO
State : FL
Zip : 32814-6645
Country : US
Telephone Number : 727-735-3586
Fax Number :
Provider Business Practice Location Address
First Line : 4887 NEW BROAD ST
Second Line : APT 2013
City : ORLANDO
State : FL
Zip : 32814-6645
Country : US
Telephone Number : 727-735-3586
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/09/2011
Last Update Date : 05/09/2011

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Directions to “ JESSICA SHIRLEY MARDER ” Practice Location

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