Provider Demographics
NPI:1962526780
Name:HENDON, MARVIN KEITH (PHD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:KEITH
Last Name:HENDON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 NORTH WASHINGTON BOULEVARD
Mailing Address - Street 2:308
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34236
Mailing Address - Country:US
Mailing Address - Phone:941-316-0230
Mailing Address - Fax:941-316-0246
Practice Address - Street 1:240 NORTH WASHINGTON BOULEVARD
Practice Address - Street 2:308
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236
Practice Address - Country:US
Practice Address - Phone:941-316-0230
Practice Address - Fax:941-316-0246
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3823103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21263816879OtherBEECHSTREET
FL503289OtherVALUE OPTIONS
FL236417OtherAMERIGROUP
FL287365OtherWELLCARE OF FLORIDA
FL287365OtherWELLCARE OF FLORIDA