Provider Demographics
NPI:1962233569
Name:MARRERO FERNANDEZ, MAYLEN
Entity type:Individual
Prefix:
First Name:MAYLEN
Middle Name:
Last Name:MARRERO FERNANDEZ
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 1:10040 SW 38TH TER
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3940
Mailing Address - Country:US
Mailing Address - Phone:786-616-7113
Mailing Address - Fax:
Practice Address - Street 1:10040 SW 38TH TER
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3940
Practice Address - Country:US
Practice Address - Phone:786-616-7113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-13
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician