Provider Demographics
NPI:1194812792
Name:SCHULTZ, MARCIA LYNNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:LYNNE
Last Name:SCHULTZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9951 NW 38TH ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-2830
Mailing Address - Country:US
Mailing Address - Phone:954-752-7707
Mailing Address - Fax:954-752-9562
Practice Address - Street 1:3111 N UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-5086
Practice Address - Country:US
Practice Address - Phone:954-649-1957
Practice Address - Fax:954-752-9562
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4717103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73941BMedicare ID - Type UnspecifiedMEDICARE