Provider Demographics
NPI:1457359051
Name:MARRERO, MAGALY VICTORIA (PHD)
Entity type:Individual
Prefix:DR
First Name:MAGALY
Middle Name:VICTORIA
Last Name:MARRERO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11124 WURZBACH RD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-2445
Mailing Address - Country:US
Mailing Address - Phone:210-698-9093
Mailing Address - Fax:210-699-4810
Practice Address - Street 1:11124 WURZBACH RD
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-2438
Practice Address - Country:US
Practice Address - Phone:210-698-9093
Practice Address - Fax:210-699-4810
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-08
Last Update Date:2008-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX23562103TA0400X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TF0000X, 103TF0200X, 103TH0100X, 103TP2701X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00B05AOtherBLUE CROSS BLUE SHIELD
TX039028802Medicaid
TX5884108OtherAETNA
TX352765100OtherDEPARTMENT OF LABOR
TX5884108OtherAETNA
TXS10777Medicare UPIN