Provider Demographics
NPI:1619390580
Name:MARIKLE, SUSANA QUINTANA (PSYD)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:QUINTANA
Last Name:MARIKLE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9555 FRANGIPANI DR
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-4524
Mailing Address - Country:US
Mailing Address - Phone:954-562-7368
Mailing Address - Fax:
Practice Address - Street 1:9555 FRANGIPANI DR
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-4524
Practice Address - Country:US
Practice Address - Phone:954-562-7368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-29
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8932103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical