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NPI Code Detail

MEDICARE: DR. MARIEMILIA LARREA PSY.D.

MEDICARE: DR. MARIEMILIA LARREA PSY.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramFL
2390200000XStudent in an Organized Health Care Education/Training ProgramGA

General Provider Information

NPI Number : 1205610961
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MARIEMILIA LARREA PSY.D.
Provider Business Mailing Address
First Line : 3699 LENOX RD NE APT 556
Second Line :
City : ATLANTA
State : GA
Zip : 30305-3881
Country : US
Telephone Number : 239-603-4365
Fax Number :
Provider Business Practice Location Address
First Line : 32 LENOX POINTE NE
Second Line :
City : ATLANTA
State : GA
Zip : 30324-5699
Country : US
Telephone Number : 404-590-0398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2023
Last Update Date : 08/23/2023

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