Provider Demographics
NPI:1508005869
Name:MARTA MANRIQUE-REICHARD, PH. D., INC.
Entity Type:Organization
Organization Name:MARTA MANRIQUE-REICHARD, PH. D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTA
Authorized Official - Middle Name:ELENA
Authorized Official - Last Name:MANRIQUE-REICHARD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:305-669-0019
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5809103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty