Provider Demographics
NPI:1285455774
Name:MARTY, GUILIANA
Entity type:Individual
Prefix:
First Name:GUILIANA
Middle Name:
Last Name:MARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1143 CRAFTSLAND LN NE
Mailing Address - Street 2:
Mailing Address - City:PALM BAY
Mailing Address - State:FL
Mailing Address - Zip Code:32905-4415
Mailing Address - Country:US
Mailing Address - Phone:321-405-9803
Mailing Address - Fax:
Practice Address - Street 1:2740 N HARBOR CITY BLVD FL 32935
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6291
Practice Address - Country:US
Practice Address - Phone:321-622-6884
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician