Provider Demographics
NPI:1699749846
Name:MCCAIN, MARIANNE L (PHD)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:L
Last Name:MCCAIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 MIRACLE STRIP PKWY SW
Mailing Address - Street 2:SUITE 32A
Mailing Address - City:FT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32548-5200
Mailing Address - Country:US
Mailing Address - Phone:850-664-7690
Mailing Address - Fax:850-664-7691
Practice Address - Street 1:348 MIRACLE STRIP PKWY SW
Practice Address - Street 2:SUITE 32A
Practice Address - City:FT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548-5200
Practice Address - Country:US
Practice Address - Phone:850-664-7690
Practice Address - Fax:850-664-7691
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004162103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73565Medicare ID - Type Unspecified