MEDICARE: DR. MANOBALDO MARCOS AMARAL PSYCHOLOGIST

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	103T00000X	Psychologist	7884	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	463398	OTHER	MA	PROVIDER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	020595820-01	OTHER	MA	PROVIDER
4	W 06139	OTHER	MA	PROVIDER
5	032608609	OTHER	MA	PROVIDER
6	456369000	OTHER	MA	PROVIDER

General Provider Information

NPI Number	:	1619053915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MANOBALDO MARCOS AMARAL PSYCHOLOGIST

Provider Business Mailing Address
First Line	:	111 KITTREDGE ST
Second Line	:
City	:	ROSLINDALE
State	:	MA
Zip	:	02131-3504
Country	:	US
Telephone Number	:	617-327-8783
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 MASSACHUSETTS AVE
Second Line	:
City	:	ARLINGTON
State	:	MA
Zip	:	02474-6799
Country	:	US
Telephone Number	:	857-472-4512
Fax Number	:

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

Provider Enumeration Date	:	10/29/2006
Last Update Date	:	07/09/2007

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