MEDICARE: DR. MARISA MAURO 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	103T00000X	Psychologist	22475	CA
2	103T00000X	Psychologist	34652	TX

General Provider Information

NPI Number	:	1669603932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARISA MAURO PSY.D.

Provider Business Mailing Address
First Line	:	316 W 12TH ST
Second Line	:	STE 602
City	:	AUSTIN
State	:	TX
Zip	:	78701-1815
Country	:	US
Telephone Number	:	512-551-0601
Fax Number	:

Provider Business Practice Location Address
First Line	:	316 W 12TH ST
Second Line	:	SUITE 602
City	:	AUSTIN
State	:	TX
Zip	:	78701-1815
Country	:	US
Telephone Number	:	512-551-0601
Fax Number	:

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

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	01/13/2014

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