Provider Demographics
NPI:1912599697
Name:HOWARD, MARLON JR
Entity type:Individual
Prefix:
First Name:MARLON
Middle Name:
Last Name:HOWARD
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 52ND AVE N LOT 76
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33714-2510
Mailing Address - Country:US
Mailing Address - Phone:727-225-8392
Mailing Address - Fax:
Practice Address - Street 1:2500 52ND AVE N LOT 76
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33714-2510
Practice Address - Country:US
Practice Address - Phone:727-225-8392
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician