Provider Demographics
NPI:1942536743
Name:MARCELLUS, MAGALIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MAGALIE
Middle Name:
Last Name:MARCELLUS
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 1:3361 SEABREEZE LANE
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-8335
Mailing Address - Country:US
Mailing Address - Phone:954-978-3206
Mailing Address - Fax:
Practice Address - Street 1:2900 W PROSPECT RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33309-2519
Practice Address - Country:US
Practice Address - Phone:954-677-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-29
Last Update Date:2009-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW64341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical