Provider Demographics
NPI:1659432151
Name:TABONE, MARCEL M (PSYD)
Entity Type:Individual
Prefix:
First Name:MARCEL
Middle Name:M
Last Name:TABONE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6550 DELILAH RD STE 301
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-5102
Mailing Address - Country:US
Mailing Address - Phone:609-272-8580
Mailing Address - Fax:609-645-7343
Practice Address - Street 1:501 SCARBOROUGH DR
Practice Address - Street 2:3RD FLR., EAST WING
Practice Address - City:EGG HARBOR TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:08234-4897
Practice Address - Country:US
Practice Address - Phone:609-646-5142
Practice Address - Fax:609-645-7343
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2018-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05223200104100000X
NJ35SI00500500103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q25861Medicare UPIN
NJ327801CB8Medicare PIN