Provider Demographics
NPI:1124555305
Name:TELLO-MARZOL, RONALD (LPC)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:TELLO-MARZOL
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ROLLING DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2020
Mailing Address - Country:US
Mailing Address - Phone:302-668-6118
Mailing Address - Fax:
Practice Address - Street 1:2 ROLLING DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2020
Practice Address - Country:US
Practice Address - Phone:302-668-6118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000735101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEPC-0000735OtherLICENSE