MEDICARE: MISS SANDIA MARCELLON 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	SW16139	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538629506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS SANDIA MARCELLON LCSW

Provider Business Mailing Address
First Line	:	1324 NW 5TH AVE APT 2
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-6052
Country	:	US
Telephone Number	:	549-380-0559
Fax Number	:

Provider Business Practice Location Address
First Line	:	1324 NW 5TH AVE APT 2
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33311-6052
Country	:	US
Telephone Number	:	549-380-0559
Fax Number	:

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

Provider Enumeration Date	:	03/25/2019
Last Update Date	:	04/05/2020

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