Provider Demographics
NPI:1487242046
Name:JALLOW-MARINUCCI, MATTIE ZARIA
Entity type:Individual
Prefix:
First Name:MATTIE
Middle Name:ZARIA
Last Name:JALLOW-MARINUCCI
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 1:3435 S ORANGE AVE APT R101
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-8516
Mailing Address - Country:US
Mailing Address - Phone:914-314-9163
Mailing Address - Fax:
Practice Address - Street 1:12315 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4507
Practice Address - Country:US
Practice Address - Phone:407-964-1152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician