Healthcare Provider Details

I. General information

NPI: 1659752467
Provider Name (Legal Business Name): MARCELLUS R CEPHAS MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2015
Last Update Date: 02/10/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7610 CARROLL AVENUE, SUITE 470
TAKOMA PARK MD
20912-6312
US

IV. Provider business mailing address

7610 CARROLL AVENUE, SUITE 470
TAKOMA PARK MD
20912-6312
US

V. Phone/Fax

Practice location:
  • Phone: 301-891-2077
  • Fax: 301-576-7397
Mailing address:
  • Phone: 301-891-2077
  • Fax: 301-576-7397

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLC3762
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17917
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13814
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberD0059532
License Number StateMD

VIII. Authorized Official

Name: DR. MARCELLUS RYAN CEPHAS
Title or Position: OWNER-MEDICAL DIRECTOR
Credential: M.D.
Phone: 301-891-2077