Provider Demographics
NPI:1215332424
Name:CLINE, MARIAN LORRIANE (BCBA, LMHC)
Entity type:Individual
Prefix:
First Name:MARIAN
Middle Name:LORRIANE
Last Name:CLINE
Suffix:
Gender:F
Credentials:BCBA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1731 SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33755-2855
Mailing Address - Country:US
Mailing Address - Phone:727-686-3229
Mailing Address - Fax:727-799-4632
Practice Address - Street 1:1731 SCOTT ST
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33755-2855
Practice Address - Country:US
Practice Address - Phone:727-351-3142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-30
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14168101YM0800X
FLMH 14168101YM0800X
FL1-10-7103103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113013100Medicaid