Provider Demographics
NPI:1861061764
Name:MARAVI, ANGIE ALICIA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANGIE
Middle Name:ALICIA
Last Name:MARAVI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGIE
Other - Middle Name:ALICIA
Other - Last Name:FLORES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1336 POTENZA DR
Mailing Address - Street 2:
Mailing Address - City:WEST MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-9207
Mailing Address - Country:US
Mailing Address - Phone:786-541-6070
Mailing Address - Fax:
Practice Address - Street 1:1336 POTENZA DR
Practice Address - Street 2:
Practice Address - City:WEST MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-9207
Practice Address - Country:US
Practice Address - Phone:786-541-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW180591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical