Provider Demographics
NPI:1679650113
Name:DI FEDELE, MARCELLA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARCELLA
Middle Name:
Last Name:DI FEDELE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HWY 537
Mailing Address - Street 2:
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2118
Mailing Address - Country:US
Mailing Address - Phone:732-598-1365
Mailing Address - Fax:
Practice Address - Street 1:331 NEWMAN SPRINGS RD STE 143
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-6767
Practice Address - Country:US
Practice Address - Phone:732-598-1365
Practice Address - Fax:732-598-1365
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC000836001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical