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NPI Code Detail

MEDICARE: LETISHA MARRERO PH.D.

MEDICARE: LETISHA MARRERO 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
1103TC0700XClinical Psychologist016787NY

General Provider Information

NPI Number : 1861571390
Entity Type Code : Individual
Provider Name (Legal Business Name) : LETISHA MARRERO PH.D.
Provider Business Mailing Address
First Line : 5635 NETHERLAND AVE
Second Line : APT 5 G
City : BRONX
State : NY
Zip : 10471-1739
Country : US
Telephone Number : 718-884-3789
Fax Number :
Provider Business Practice Location Address
First Line : NORTH CENTRAL BRONX HOSPITAL
Second Line : 3424 KOSSUTH AVENUE
City : BRONX
State : NY
Zip : 10467
Country : US
Telephone Number : 718-519-4965
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2006
Last Update Date : 07/08/2007

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