Provider Demographics
NPI:1669603932
Name:MAURO, MARISA (PSYD)
Entity type:Individual
Prefix:DR
First Name:MARISA
Middle Name:
Last Name:MAURO
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 W 12TH ST
Mailing Address - Street 2:STE 602
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1815
Mailing Address - Country:US
Mailing Address - Phone:512-551-0601
Mailing Address - Fax:
Practice Address - Street 1:316 W 12TH ST
Practice Address - Street 2:SUITE 602
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1815
Practice Address - Country:US
Practice Address - Phone:512-551-0601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-04
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22475103T00000X
TX34652103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist