Provider Demographics
NPI:1730274549
Name:JOLICOEUR, MARTINE (MHSA)
Entity type:Individual
Prefix:MS
First Name:MARTINE
Middle Name:
Last Name:JOLICOEUR
Suffix:
Gender:F
Credentials:MHSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7170 LAKE ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7952
Mailing Address - Country:US
Mailing Address - Phone:561-308-9067
Mailing Address - Fax:352-392-7829
Practice Address - Street 1:1600 SW ARCHER RD RM HD116
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-334-1520
Practice Address - Fax:352-392-7829
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2017-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker