Provider Demographics
NPI:1386620417
Name:MARRERO, BERNABE (PHD)
Entity type:Individual
Prefix:
First Name:BERNABE
Middle Name:
Last Name:MARRERO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:BERNIE
Other - Middle Name:
Other - Last Name:MARRERO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4881 NW 8TH AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-4582
Mailing Address - Country:US
Mailing Address - Phone:352-416-1082
Mailing Address - Fax:352-373-6144
Practice Address - Street 1:4343 W NEWBERRY RD
Practice Address - Street 2:SUITE 2
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32607-2822
Practice Address - Country:US
Practice Address - Phone:352-332-9441
Practice Address - Fax:352-331-6550
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-20
Last Update Date:2019-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY04706103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL54099YMedicare ID - Type Unspecified
FLS29489Medicare UPIN