Provider Demographics
NPI:1093226094
Name:BACELONIA, MARNEIL
Entity Type:Individual
Prefix:MR
First Name:MARNEIL
Middle Name:
Last Name:BACELONIA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7145 18TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98106-1811
Mailing Address - Country:US
Mailing Address - Phone:206-349-4502
Mailing Address - Fax:
Practice Address - Street 1:7145 18TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98106
Practice Address - Country:US
Practice Address - Phone:206-349-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician