MEDICARE: MARCELLE MARTELLY PH.D., LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	SW 4351	FL

General Provider Information

NPI Number	:	1013940873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELLE MARTELLY PH.D., LCSW

Provider Business Mailing Address
First Line	:	1440 NE 201ST TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-5144
Country	:	US
Telephone Number	:	305-934-7463
Fax Number	:	305-655-0830

Provider Business Practice Location Address
First Line	:	1440 NE 201ST TER
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33179-5144
Country	:	US
Telephone Number	:	305-934-7463
Fax Number	:	305-655-0830

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2006
Last Update Date	:	07/08/2007

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