Provider Demographics
NPI:1962154468
Name:GRUNDHOEFER, MARIANNE (MS)
Entity type:Individual
Prefix:
First Name:MARIANNE
Middle Name:
Last Name:GRUNDHOEFER
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2717 W CYPRESS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33309-1703
Mailing Address - Country:US
Mailing Address - Phone:954-979-7911
Mailing Address - Fax:
Practice Address - Street 1:21552 BELHAVEN WAY
Practice Address - Street 2:
Practice Address - City:ESTERO
Practice Address - State:FL
Practice Address - Zip Code:33928-3283
Practice Address - Country:US
Practice Address - Phone:251-504-0124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-25
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH21986101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health