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General NPI Number Information
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NPI Number | 1790598332
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Entity Type | Individual
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Provider Name | MARIO MARCELLUS
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Gender | Male
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/29/2025
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Provider Practice Location Address
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Address Line | 1000 COLOR PL # 101
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City | APOPKA
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State | FL
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Zip | 32703-7717
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Country | US
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Telephone | 888-754-0398
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Fax |
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Provider Business Mailing Address
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Address Line | 2150 ROCKMART LOOP
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City | TAVARES
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State | FL
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Zip | 32778-8556
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Country | US
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Telephone | 407-633-8509
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Fax |
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-24-78486
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License Number State | FL
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