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General NPI Number Information
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NPI Number | 1154668861
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Entity Type | Individual
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Provider Name | TANIA I MARRERO PSYD
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Gender | Female
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Dates
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Enumeration Date | 01/15/2013
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 4735 OLD CANOE CREEK RD
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City | SAINT CLOUD
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State | FL
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Zip | 34769-1400
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Country | US
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Telephone | 212-573-9603
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Fax | 407-604-7677
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Provider Business Mailing Address
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Address Line | 4735 OLD CANOE CREEK RD
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City | SAINT CLOUD
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State | FL
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Zip | 34769-1400
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Country | US
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Telephone | 321-257-3960
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Fax | 407-604-7677
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 004740
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY10072
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License Number State | FL
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