Provider Demographics
NPI:1861426512
Name:HETU, MARIE CHRISTINE (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARIE
Middle Name:CHRISTINE
Last Name:HETU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:MARIE
Other - Middle Name:HETU
Other - Last Name:MCDONALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:51 WALLACE AVENUE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6025
Mailing Address - Country:US
Mailing Address - Phone:941-954-8978
Mailing Address - Fax:941-921-6182
Practice Address - Street 1:51 WALLACE AVENUE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6025
Practice Address - Country:US
Practice Address - Phone:941-954-8978
Practice Address - Fax:941-921-6182
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2010-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004236103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73569Medicare ID - Type Unspecified