Provider Demographics
NPI:1215132667
Name:DEPREY, MARILYN (LMHC)
Entity type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:
Last Name:DEPREY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3824 HICKORY LN
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-7103
Mailing Address - Country:US
Mailing Address - Phone:904-797-8611
Mailing Address - Fax:904-471-6236
Practice Address - Street 1:2180 A1A S STE 102
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-6523
Practice Address - Country:US
Practice Address - Phone:904-460-0208
Practice Address - Fax:904-471-6236
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6248101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health