Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 23562 | TX |
N | 103TA0700X | Adult Development & Aging Psychologist | 23562 | TX |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 23562 | TX |
Y | 103G00000X | Clinical Psychologist | 23562 | TX |
Y | 103TC0700X | Clinical Psychologist | 23562 | TX |
N | 103TC1900X | Counseling Psychologist | 23562 | TX |
N | 103TF0000X | Family Psychologist | 23562 | TX |
N | 103TF0200X | Forensic Psychologist | 23562 | TX |
N | 103TH0100X | Health Service | 23562 | TX |
N | 103TP2701X | Group Psychotherapist | 23562 | TX |
N | 103TR0400X | Rehabilitation Psychologist | 23562 | TX |
NPI | 1457359051 |
---|---|
Provider Name | Dr. Magaly Victoria Marrero |
First Address | San Antonio, TX 78230-2445 |
Second Address | San Antonio, TX 78230-2438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/07/2005 |
Last Update Date | 03/10/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00B05A | BLUE CROSS BLUE SHIELD (01) | TX |
039028802 | (05) | TX |
352765100 | DEPARTMENT OF LABOR (01) | TX |
5884108 | AETNA (01) | TX |
S10777 | (02) | TX |