MEDICARE: DR. MEGAN ANNE BARTHLE-HERRERA PH.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	103TB0200X	Cognitive & Behavioral Psychologist	PY10538	FL
2	103TC1900X	Counseling Psychologist	PY10538	FL
3	103TC2200X	Clinical Child & Adolescent Psychologist	PY10538	FL
4	103T00000X	Psychologist	PY10538	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780231902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MEGAN ANNE BARTHLE-HERRERA PH.D.

Provider Business Mailing Address
First Line	:	4197 NW 86TH TER
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-9278
Country	:	US
Telephone Number	:	352-265-4357
Fax Number	:	352-627-4161

Provider Business Practice Location Address
First Line	:	4197 NW 86TH TER
Second Line	:
City	:	GAINESVILLE
State	:	FL
Zip	:	32606-9278
Country	:	US
Telephone Number	:	352-265-4357
Fax Number	:	352-627-4161

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

Provider Enumeration Date	:	08/22/2019
Last Update Date	:	08/22/2019

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