Provider Demographics
NPI:1053621284
Name:SURETTE, MARGUERITE MARIE (MA)
Entity type:Individual
Prefix:
First Name:MARGUERITE
Middle Name:MARIE
Last Name:SURETTE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:MARGAUX
Other - Middle Name:
Other - Last Name:SURETTE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:PO BOX 975
Mailing Address - Street 2:
Mailing Address - City:OSPREY
Mailing Address - State:FL
Mailing Address - Zip Code:34229-0975
Mailing Address - Country:US
Mailing Address - Phone:941-483-6348
Mailing Address - Fax:941-404-4034
Practice Address - Street 1:901 VENETIA BAY BLVD
Practice Address - Street 2:SUITE 356
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-8041
Practice Address - Country:US
Practice Address - Phone:941-483-6348
Practice Address - Fax:941-404-4034
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2013-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 11523101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health