1790774438 NPI number — DR. MARLENE M KASTRINOS PHD, LCSW

Table of content: DR. MARLENE M KASTRINOS PHD, LCSW (NPI 1790774438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790774438 NPI number — DR. MARLENE M KASTRINOS PHD, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASTRINOS
Provider First Name:
MARLENE
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790774438
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9380 SW 72 ST
Provider Second Line Business Mailing Address:
SUITE B 238
Provider Business Mailing Address City Name:
MIAMI
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33173-5489
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-667-2430
Provider Business Mailing Address Fax Number:
305-271-6773

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9408 SW 87TH AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33176-2416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-769-3524
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  SW5884 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7449266 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 887512000 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110688 . This is a "AMERIGROUP ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 256975 . This is a "MANAGED HEALTH NETWORK" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: NZ710 . This is a "EMPIRE BLUE CROSS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 240335 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 9222748 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: PVPB 170322 . This is a "APS HEALTHCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 192456 . This is a "COMPSYCH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 115257900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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