MEDICARE: ROMAN MARCUS CARRASCO 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
1	103TC0700X	Clinical Psychologist	PY10726	FL
2	103G00000X	Clinical Neuropsychologist	PY10726	FL

General Provider Information

NPI Number	:	1083923718
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROMAN MARCUS CARRASCO PSY.D.

Provider Business Mailing Address
First Line	:	265 E ROLLINS ST # 6
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-5502
Country	:	US
Telephone Number	:	407-821-3584
Fax Number	:

Provider Business Practice Location Address
First Line	:	265 E ROLLINS ST # 6
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32804-5502
Country	:	US
Telephone Number	:	407-821-3584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2010
Last Update Date	:	02/07/2024

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