MEDICARE: DR. MARILYN BACARELLA PSY.D.

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	103T00000X	Psychologist	PS005349L	PA
2	103TC0700X	Clinical Psychologist	PS005349L	PA
3	103TS0200X	School Psychologist	PS005349L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	161866	OTHER	PA	VALUE OPTIONS MHS#
2	322375	OTHER	PA	MHN PRACTITIONER ID NUMBE

General Provider Information

NPI Number	:	1821150632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILYN BACARELLA PSY.D.

Provider Business Mailing Address
First Line	:	146 MONTGOMERY AVE
Second Line	:	SUITE 302
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-2956
Country	:	US
Telephone Number	:	610-667-6420
Fax Number	:	610-667-6421

Provider Business Practice Location Address
First Line	:	146 MONTGOMERY AVE
Second Line	:	SUITE 302
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-2956
Country	:	US
Telephone Number	:	610-667-6420
Fax Number	:	610-667-6421

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

Provider Enumeration Date	:	12/15/2006
Last Update Date	:	09/11/2025

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