Marina Christine Declue

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

MH21644 Issued in FL

Practice address

155 Guava Street
Punta Gorda, FL 33980

Phone

(239) 672-6177

NPI assigned

Feb 4, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Mrs. Marina Christine Kroeter Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

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.

• Shine Medical Providers PC

  • Psychiatry Physician
  • Philadelphia, PA
  • NPI 1538894050
  NPD (past)

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

{
    "created_epoch": "1612396800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1720670458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "155 GUAVA STREET",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "33980",
            "telephone_number": "239-672-6177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 GUAVA STREET",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "33980",
            "telephone_number": "239-672-6177"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DECLUE",
        "first_name": "MARINA",
        "middle_name": "CHRISTINE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-02-04",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH21644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARINA",
            "last_name": "KROETER",
            "middle_name": "CHRISTINE",
            "prefix": "MRS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Emil A. Dameff, M.D.
• Daniel Bass Goldman
• Deborah Daniels
• Nora Ann Davis, MS ARNP PNP-BC
• Catherine E Deaett
• Deep Creek Eye Care LLC
• Elmire Degraff
• David Heberto Del Castillo, MSN, FNP-C
• Estevan James Del Castillo, MD
• Amanda Del Sol Echarte

• Mental Health Counselor in Punta Gorda, FL
• Providers in Punta Gorda, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 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.