Provider Demographics
NPI:1821150632
Name:BACARELLA, MARILYN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARILYN
Middle Name:
Last Name:BACARELLA
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 MONTGOMERY AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2956
Mailing Address - Country:US
Mailing Address - Phone:610-667-6420
Mailing Address - Fax:610-667-6421
Practice Address - Street 1:146 MONTGOMERY AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2956
Practice Address - Country:US
Practice Address - Phone:610-667-6420
Practice Address - Fax:610-667-6421
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005349L103T00000X, 103TC0700X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA161866OtherVALUE OPTIONS MHS#
PA322375OtherMHN PRACTITIONER ID NUMBE
PA075195Medicare UPIN