Provider Demographics
NPI:1871733881
Name:CELONY, MARIE ALIX (MBA)
Entity type:Individual
Prefix:
First Name:MARIE
Middle Name:ALIX
Last Name:CELONY
Suffix:
Gender:F
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SHERIDAN ST STE J
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3416
Mailing Address - Country:US
Mailing Address - Phone:305-330-0284
Mailing Address - Fax:954-362-7376
Practice Address - Street 1:4700 SHERIDAN ST STE J
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3416
Practice Address - Country:US
Practice Address - Phone:305-330-0284
Practice Address - Fax:954-362-7376
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2018-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL689981100Medicaid