Provider Demographics
NPI:1225197684
Name:BLAIR HALL, MARCELLE IDETTE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARCELLE
Middle Name:IDETTE
Last Name:BLAIR HALL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARCELLE
Other - Middle Name:IDETTE
Other - Last Name:BANKS-BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:2150 SPRINGHOUSE HOLW
Mailing Address - Street 2:
Mailing Address - City:GARNET VALLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19060-2116
Mailing Address - Country:US
Mailing Address - Phone:610-800-2475
Mailing Address - Fax:
Practice Address - Street 1:205 N MONROE ST
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-3052
Practice Address - Country:US
Practice Address - Phone:610-800-2475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0163201041C0700X
DEQ1-00012541041C0700X
PASW125167104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical