Provider Demographics
NPI:1821085713
Name:MANRIQUE-REICHARD, MARTA (PHD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:
Last Name:MANRIQUE-REICHARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5940 SW 73RD ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SOUTH MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-8700
Mailing Address - Country:US
Mailing Address - Phone:305-669-0019
Mailing Address - Fax:305-669-0029
Practice Address - Street 1:5940 SW 73RD ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SOUTH MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-8700
Practice Address - Country:US
Practice Address - Phone:305-669-0019
Practice Address - Fax:305-669-0029
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 5809103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54444XOtherMEDICARE