Provider Demographics
NPI:1447463849
Name:EVERETTE, MAUREEN CATHERINE (MA,LMHC)
Entity type:Individual
Prefix:MRS
First Name:MAUREEN
Middle Name:CATHERINE
Last Name:EVERETTE
Suffix:
Gender:F
Credentials:MA,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 MALIBU LANE
Mailing Address - Street 2:
Mailing Address - City:INDIALANTIC
Mailing Address - State:FL
Mailing Address - Zip Code:32903
Mailing Address - Country:US
Mailing Address - Phone:321-777-6318
Mailing Address - Fax:321-777-2178
Practice Address - Street 1:3270 SUNTREE BLVD.
Practice Address - Street 2:#109
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940
Practice Address - Country:US
Practice Address - Phone:321-751-0155
Practice Address - Fax:321-751-0079
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH7231101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health