Provider Demographics
NPI:1790961696
Name:MARCELO, ELPIDO B (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELPIDO
Middle Name:B
Last Name:MARCELO
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 1:11703 BARBERRY COURT
Mailing Address - Street 2:
Mailing Address - City:HUNTLEY
Mailing Address - State:IL
Mailing Address - Zip Code:60142
Mailing Address - Country:US
Mailing Address - Phone:847-456-6498
Mailing Address - Fax:847-456-6498
Practice Address - Street 1:11703 BARBERRY COURT
Practice Address - Street 2:
Practice Address - City:HUNTLEY
Practice Address - State:IL
Practice Address - Zip Code:60142
Practice Address - Country:US
Practice Address - Phone:847-456-6498
Practice Address - Fax:847-456-6498
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2011-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071005592103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical