MEDICARE: SAMANTHA MARASA PHD, LP

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	39944	TX
2	171W00000X	Contractor

General Provider Information

NPI Number	:	1891447561
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SAMANTHA MARASA PHD, LP

Provider Business Mailing Address
First Line	:	800 WOLF RANCH PKWY APT 9200
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78628-2247
Country	:	US
Telephone Number	:	618-980-9026
Fax Number	:

Provider Business Practice Location Address
First Line	:	36000 DARNALL LOOP
Second Line	:
City	:	FORT HOOD
State	:	TX
Zip	:	76544-5095
Country	:	US
Telephone Number	:	618-980-9026
Fax Number	:

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

Provider Enumeration Date	:	01/24/2022
Last Update Date	:	12/16/2025

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