Marisa Bartolo

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

150 Southpark Blvd Ste 202
St Augustine, FL 32086-5179

Phone

(904) 217-3103

Fax

(904) 467-3422

NPI assigned

Oct 25, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ride the Wave Therapy Services

  • Multi-Specialty Clinic/Center
  • Saint Augustine, FL
  • NPI 1467068023
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1666656000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666656000000",
    "number": "1437876927",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7635 TIMBERLIN PARK BLVD APT 316",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322566720",
            "telephone_number": "904-687-4860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "150 SOUTHPARK BLVD STE 202",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320865179",
            "telephone_number": "904-217-3103",
            "fax_number": "904-467-3422"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BARTOLO",
        "first_name": "MARISA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-25",
        "last_updated": "2022-10-25",
        "certification_date": "2022-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Barrow, LCSW
• Barry F Dobies MD PA
• Patricia Barry, RPH
• Vonda Mary Bartlett, CD
• Valerie Lynne Bartol, M.A.
• Jessica Nicole Bash, SLP
• Shazia Bashir, M.D,
• Caitlin Lizbeth Bass, M.D.
• Ellen Joy Bass, DPT
• Ashley Bastin

• Behavior Technician in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Behavior Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.