Provider Demographics
NPI:1770050247
Name:CLINICA DR MARRERO LLC
Entity type:Organization
Organization Name:CLINICA DR MARRERO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERTO
Authorized Official - Middle Name:CARLOS
Authorized Official - Last Name:MARRERO GRATACOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-847-4270
Mailing Address - Street 1:PO BOX 43
Mailing Address - Street 2:
Mailing Address - City:VILLALBA
Mailing Address - State:PR
Mailing Address - Zip Code:00766-0043
Mailing Address - Country:US
Mailing Address - Phone:787-847-4270
Mailing Address - Fax:787-847-3057
Practice Address - Street 1:16 CALLE MUNOZ RIVERA
Practice Address - Street 2:
Practice Address - City:VILLALBA
Practice Address - State:PR
Practice Address - Zip Code:00766-3029
Practice Address - Country:US
Practice Address - Phone:787-847-4270
Practice Address - Fax:787-847-3057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty