MEDICARE: ASHLEY MARIE MARCELLUS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMT4173	FL

General Provider Information

NPI Number	:	1083444772
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ASHLEY MARIE MARCELLUS

Provider Business Mailing Address
First Line	:	1271 SW 29TH TER
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-2854
Country	:	US
Telephone Number	:	786-416-4565
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 E CYPRESS CREEK RD STE 431
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33334-3560
Country	:	US
Telephone Number	:	954-899-0601
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/06/2024
Last Update Date	:	08/06/2024

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Directions to “ ASHLEY MARIE MARCELLUS ” Practice Location

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