Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MH17360 | FL |
NPI | 1003171547 |
---|---|
Provider Name | Marissa Janene Mannetta |
First Address | Orlando, FL 32835-6197 |
Second Address | Orlando, FL 32835-6197 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2012 |
Last Update Date | 12/08/2020 |