Provider Demographics
NPI:1912220682
Name:MARNIE LARATRO PSYD PA
Entity Type:Organization
Organization Name:MARNIE LARATRO PSYD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LARATRO
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, PA
Authorized Official - Phone:954-483-4238
Mailing Address - Street 1:543 PALM DRIVE
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33009
Mailing Address - Country:US
Mailing Address - Phone:954-483-4238
Mailing Address - Fax:
Practice Address - Street 1:543 PALM DR
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-6533
Practice Address - Country:US
Practice Address - Phone:954-483-4238
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-09
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7894363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty