Provider Demographics
NPI:1992243745
Name:MARIE L. TRGOVAC COUNSELING, P.A.
Entity type:Organization
Organization Name:MARIE L. TRGOVAC COUNSELING, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:TRGOVAC
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:570-490-0620
Mailing Address - Street 1:1765 BANYAN DR
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-1609
Mailing Address - Country:US
Mailing Address - Phone:570-490-0620
Mailing Address - Fax:
Practice Address - Street 1:1765 BANYAN DR
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-1609
Practice Address - Country:US
Practice Address - Phone:570-490-0620
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 9611103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty