MEDICARE: CARESSA MARCINELLI

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	235Z00000X	Speech-Language Pathologist	02150	MD

General Provider Information

NPI Number	:	1841760618
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARESSA MARCINELLI

Provider Business Mailing Address
First Line	:	4537 CHEWS VINEYARD
Second Line	:
City	:	ELLICOTT CITY
State	:	MD
Zip	:	21043-6675
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6501 DUCKETTS LN
Second Line	:
City	:	ELKRIDGE
State	:	MD
Zip	:	21075-6768
Country	:	US
Telephone Number	:	410-313-5050
Fax Number	:

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

Provider Enumeration Date	:	12/04/2018
Last Update Date	:	12/04/2018

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Directions to “ CARESSA MARCINELLI ” Practice Location

Language	Start Address	Practice Location

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