MEDICARE: DR. ELIZABETH MAGRO PSYD

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	PY7867	FL
2	103TB0200X	Cognitive & Behavioral Psychologist	PY7867	FL
3	103TC0700X	Clinical Psychologist	PY7867	FL
4	103TC1900X	Counseling Psychologist	PY7867	FL
5	103TC2200X	Clinical Child & Adolescent Psychologist	PY7867	FL

General Provider Information

NPI Number	:	1811123052
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH MAGRO PSYD

Provider Business Mailing Address
First Line	:	1726 CONNECTICUT AVE NE
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33703-5433
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	926 16TH ST N
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33705-1211
Country	:	US
Telephone Number	:	727-481-9983
Fax Number	:	727-289-4962

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

Provider Enumeration Date	:	06/02/2009
Last Update Date	:	08/13/2012

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