Individual provider Active NPI

Tania I Marrero, PSYD

  • Clinical Psychologist
  • Saint Cloud, FL
National Provider Identifier
1154668861
Registry record updated Jan 10, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY10072 Issued in FL
Practice address
4735 Old Canoe Creek Rd
Saint Cloud, FL 34769-1400
Phone
(212) 573-9603
Fax
(407) 604-7677
NPI assigned
Jan 15, 2013
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 10, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 004740 PR
Clinical Psychologist 103TC0700X PY10072 FL Primary

Addresses

Primary practice location

4735 Old Canoe Creek Rd
Saint Cloud, FL 34769-1400

Mailing address

4735 Old Canoe Creek Rd
Saint Cloud, FL 34769-1400
Phone (321) 257-3960

Other practice location 1

161 Ave Ponce De Leon Ste 206
San Juan, PR 00917-1253
Phone (787) 674-4864

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20180516002923 FL Practitioner - Clinical Psychologist 5597020784 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Positive Mindset GroupGroup PAC ID 6002227485, 2 clinicians

Practice addresses (Care Compare)

4735 Old Canoe Creek Rd
Saint Cloud, FL 34769-1400
Phone (321) 257-3960

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
004740PRMDClinical Psychologist

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1358208000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1154668861",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4735 OLD CANOE CREEK RD",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347691400",
            "telephone_number": "321-257-3960",
            "fax_number": "407-604-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4735 OLD CANOE CREEK RD",
            "city": "SAINT CLOUD",
            "state": "FL",
            "postal_code": "347691400",
            "telephone_number": "212-573-9603",
            "fax_number": "407-604-7677"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "161 Ave Ponce De Leon Ste 206",
            "address_purpose": "LOCATION",
            "city": "San Juan",
            "state": "PR",
            "postal_code": "009171253",
            "country_code": "US",
            "telephone_number": "787-674-4864",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARRERO",
        "first_name": "TANIA",
        "middle_name": "I",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-01-15",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "PR",
            "license": "004740",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY10072",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Cloud, FL

Sources for this page

Verify at the official NPI Registry.