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
1	103TC0700X	Clinical Psychologist	016787	NY

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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