Provider Demographics
NPI:1588102859
Name:BATEAU, MARIE
Entity type:Individual
Prefix:MISS
First Name:MARIE
Middle Name:
Last Name:BATEAU
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:PO BOX 26121
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33320-6121
Mailing Address - Country:US
Mailing Address - Phone:954-601-6078
Mailing Address - Fax:
Practice Address - Street 1:4780 NW 24TH CT APT C215
Practice Address - Street 2:
Practice Address - City:LAUDERDALE LAKES
Practice Address - State:FL
Practice Address - Zip Code:33313-2663
Practice Address - Country:US
Practice Address - Phone:954-601-6078
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator