Provider Demographics
NPI:1558958975
Name:MARULLO, MARCUS MICHAEL (MS, LAC, CCS, AADC)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:MICHAEL
Last Name:MARULLO
Suffix:
Gender:M
Credentials:MS, LAC, CCS, AADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:648 LATIOLAIS DR
Mailing Address - Street 2:
Mailing Address - City:BREAUX BRIDGE
Mailing Address - State:LA
Mailing Address - Zip Code:70517-4231
Mailing Address - Country:US
Mailing Address - Phone:337-332-4878
Mailing Address - Fax:337-332-4866
Practice Address - Street 1:648 LATIOLAIS DR
Practice Address - Street 2:
Practice Address - City:BREAUX BRIDGE
Practice Address - State:LA
Practice Address - Zip Code:70517-4231
Practice Address - Country:US
Practice Address - Phone:337-332-4878
Practice Address - Fax:337-332-4866
Is Sole Proprietor?:No
Enumeration Date:2020-12-31
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1014101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)