Healthcare Provider Details

I. General information

NPI: 1205889151
Provider Name (Legal Business Name): MARCELO TRINIDAD-CARRILLO PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 SEMINOLE CENTRE CT STE D
FITCHBURG WI
53711-5165
US

IV. Provider business mailing address

PO BOX 930406
VERONA WI
53593-0406
US

V. Phone/Fax

Practice location:
  • Phone: 608-270-1800
  • Fax: 608-270-9731
Mailing address:
  • Phone: 608-444-8619
  • Fax: 608-270-9731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2210057
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: