Provider Demographics
NPI:1578774063
Name:DELASERNA, MARCELO (PHD)
Entity Type:Individual
Prefix:DR
First Name:MARCELO
Middle Name:
Last Name:DELASERNA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5272 AMHURST DR
Mailing Address - Street 2:
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30092-1620
Mailing Address - Country:US
Mailing Address - Phone:770-662-5108
Mailing Address - Fax:
Practice Address - Street 1:5272 AMHURST DR
Practice Address - Street 2:
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30092-1620
Practice Address - Country:US
Practice Address - Phone:770-798-7333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA798103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist