Provider Demographics
NPI:1922362599
Name:MARCELLUS, DONNA MARIE (PHN;SC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:MARCELLUS
Suffix:
Gender:F
Credentials:PHN;SC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 NEWINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GANSEVOORT
Mailing Address - State:NY
Mailing Address - Zip Code:12831-1842
Mailing Address - Country:US
Mailing Address - Phone:518-584-1001
Mailing Address - Fax:
Practice Address - Street 1:7 NEWINGTON AVE
Practice Address - Street 2:
Practice Address - City:GANSEVOORT
Practice Address - State:NY
Practice Address - Zip Code:12831-1842
Practice Address - Country:US
Practice Address - Phone:518-584-1001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-28
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator