Healthcare Provider Details

I. General information

NPI: 1568576429
Provider Name (Legal Business Name): MAURINE KATIANA MARCELLUS M.A., NCSP, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 12/19/2025
Certification Date: 12/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 490724
EVERETT MA
02149-0013
US

IV. Provider business mailing address

PO BOX 490724
EVERETT MA
02149-0013
US

V. Phone/Fax

Practice location:
  • Phone: 267-626-9697
  • Fax: 610-410-8179
Mailing address:
  • Phone: 267-626-9697
  • Fax: 610-410-8179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC004293
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: