Provider Demographics
NPI:1134907744
Name:EDOUARD, MARLINE (RBT)
Entity type:Individual
Prefix:
First Name:MARLINE
Middle Name:
Last Name:EDOUARD
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 E SR 434 STE A
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5244
Mailing Address - Country:US
Mailing Address - Phone:844-827-3258
Mailing Address - Fax:
Practice Address - Street 1:420 E SR 434 STE A
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5244
Practice Address - Country:US
Practice Address - Phone:844-827-3258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician