MEDICARE: MARNIE LARATRO PSYD PA

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	363A00000X	Physician Assistant	PY7894	FL

General Provider Information

NPI Number	:	1912220682
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARNIE LARATRO PSYD PA

Provider Business Mailing Address
First Line	:	543 PALM DRIVE
Second Line	:
City	:	HALLANDALE
State	:	FL
Zip	:	33009
Country	:	US
Telephone Number	:	954-483-4238
Fax Number	:

Provider Business Practice Location Address
First Line	:	543 PALM DR
Second Line	:
City	:	HALLANDALE BEACH
State	:	FL
Zip	:	33009-6533
Country	:	US
Telephone Number	:	954-483-4238
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. MARNIE LARATRO
Credential	:	PSY.D., P.A.
Telephone Number	:	954-483-4238

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	09/07/2010

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