Provider Demographics
NPI:1972996072
Name:ELYSE MARRONE, RD PLLC
Entity type:Organization
Organization Name:ELYSE MARRONE, RD PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELYSE
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARRONE
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:561-252-7857
Mailing Address - Street 1:1306 SONOMA CT
Mailing Address - Street 2:
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1517
Mailing Address - Country:US
Mailing Address - Phone:561-252-7857
Mailing Address - Fax:860-760-6026
Practice Address - Street 1:1306 SONOMA CT
Practice Address - Street 2:
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-1517
Practice Address - Country:US
Practice Address - Phone:561-252-7857
Practice Address - Fax:860-760-6026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLND6053251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management