Provider Demographics
NPI:1457683625
Name:CHAZARRETA, MARISA S
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:S
Last Name:CHAZARRETA
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 1:8271 SW 41ST CT
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-2943
Mailing Address - Country:US
Mailing Address - Phone:954-423-9694
Mailing Address - Fax:954-423-9694
Practice Address - Street 1:8271 SW 41ST CT
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-2943
Practice Address - Country:US
Practice Address - Phone:954-423-9694
Practice Address - Fax:954-423-9694
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-12
Last Update Date:2012-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-04-1244103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst