Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ADC-001642-2014 | FL |
NPI | 1427582949 |
---|---|
Provider Name | John Marika |
First Address | Weston, FL 33326-3340 |
Second Address | Weston, FL 33326-3340 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2017 |
Last Update Date | 12/04/2017 |