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General NPI Number Information
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NPI Number | 1083036131
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Entity Type | Organization
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Legal Business Name | MAURO PSYCHOLOGICAL SERVICES PLLC
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Dates
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Enumeration Date | 01/09/2014
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Last Update Date | 01/09/2014
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Provider Practice Location Address
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Address Line | 316 W 12TH ST SUITE 602
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City | AUSTIN
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State | TX
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Zip | 78701-1815
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Country | US
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Telephone | 512-551-0601
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Fax |
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Provider Business Mailing Address
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Address Line | 316 W 12TH ST SUITE 602
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City | AUSTIN
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State | TX
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Zip | 78701-1815
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PSYCHOLOGIST / OWNER
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Name | DR. MARISA MAURO
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Credential | PSY.D.
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Telephone | 512-551-0601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 34652
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License Number State | TX
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