MEDICARE: MR. IVAN A. MARRERO M.A.

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	103TC1900X	Counseling Psychologist	2125	PR

General Provider Information

NPI Number	:	1770785057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. IVAN A. MARRERO M.A.

Provider Business Mailing Address
First Line	:	CALLE UNION 664
Second Line	:	APTO. 205
City	:	SAN JUAN
State	:	PR
Zip	:	00907
Country	:	US
Telephone Number	:	787-723-1030
Fax Number	:

Provider Business Practice Location Address
First Line	:	CALL BOX 4964
Second Line	:
City	:	CAGUAS
State	:	PR
Zip	:	00726-4964
Country	:	US
Telephone Number	:	787-653-0550
Fax Number	:

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

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	07/08/2007

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