Provider Demographics
NPI:1568576429
Name:MARCELLUS, MAURINE KATIANA (MA, NCSP, LPC, NCC)
Entity Type:Individual
Prefix:MISS
First Name:MAURINE
Middle Name:KATIANA
Last Name:MARCELLUS
Suffix:
Gender:F
Credentials:MA, NCSP, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 786
Mailing Address - Street 2:
Mailing Address - City:WHITEHALL
Mailing Address - State:PA
Mailing Address - Zip Code:18052-0786
Mailing Address - Country:US
Mailing Address - Phone:267-626-9697
Mailing Address - Fax:610-410-8179
Practice Address - Street 1:1357 CANAL ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18067-1421
Practice Address - Country:US
Practice Address - Phone:267-626-9697
Practice Address - Fax:610-410-8179
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2010-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PAPC004293101YP2500X
PA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool