Provider Demographics
NPI:1073950887
Name:MARRERO, MARY LANE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:LANE
Last Name:MARRERO
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3489 YARIAN DR
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-6656
Mailing Address - Country:US
Mailing Address - Phone:850-566-5602
Mailing Address - Fax:
Practice Address - Street 1:297 E HIGHWAY 50 STE 1
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2500
Practice Address - Country:US
Practice Address - Phone:352-404-6589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-03
Last Update Date:2025-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW105111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019565900Medicaid