Basic Information
| Provider Information | |||||||||
| NPI: | 1376675165 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARR | ||||||||
| FirstName: | ELIZABETH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5325 GREENWOOD AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334072452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618826406 | ||||||||
| FaxNumber: | 5618810972 | ||||||||
| Practice Location | |||||||||
| Address1: | 5325 GREENWOOD AVE | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | WEST PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334072452 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5618826406 | ||||||||
| FaxNumber: | 5618810972 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/09/2007 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | FL | Y | Behavioral Health & Social Service Providers | Social Worker | 235Z00000X | SA 3897 | FL | N | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
ID Information
| ID | Type | State | Issuer | Description | 767516000 | 05 | FL | MEDICAID | 889252100 | 05 | FL | MEDICAID |