Provider Demographics
NPI:1548726102
Name:HUFF, MARISA DESTEFANO (MS, LMHC)
Entity type:Individual
Prefix:
First Name:MARISA
Middle Name:DESTEFANO
Last Name:HUFF
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 PLUM TREE LN
Mailing Address - Street 2:
Mailing Address - City:RIVIERA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33410-1905
Mailing Address - Country:US
Mailing Address - Phone:561-578-1200
Mailing Address - Fax:
Practice Address - Street 1:1555 PALM BEACH LAKES BLVD STE 1560
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2335
Practice Address - Country:US
Practice Address - Phone:561-907-4409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-19
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health