Provider Demographics
NPI:1740797596
Name:MESSINA, SERENA (PHD, LP)
Entity Type:Individual
Prefix:DR
First Name:SERENA
Middle Name:
Last Name:MESSINA
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 HYCREST DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-7314
Mailing Address - Country:US
Mailing Address - Phone:512-983-9928
Mailing Address - Fax:
Practice Address - Street 1:1907 N LAMAR BLVD STE 230
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-4929
Practice Address - Country:US
Practice Address - Phone:512-593-1655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-02
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37650103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist