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General NPI Number Information
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NPI Number | 1205889151
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Entity Type | Individual
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Provider Name | MARCELO TRINIDAD-CARRILLO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 437S YELLOWSTONE DR 208
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City | MADISON
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State | WI
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Zip | 53719-1061
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Country | US
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Telephone | 608-270-1800
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Fax | 608-270-9731
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Provider Business Mailing Address
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Address Line | PO BOX 930406
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City | VERONA
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State | WI
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Zip | 53593-0406
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Country | US
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Telephone | 608-270-1800
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Fax | 608-270-9731
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 2210057
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License Number State | WI
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