Provider Demographics
NPI:1245365014
Name:CAVALLARO, MARION LOUISE (PHD)
Entity type:Individual
Prefix:DR
First Name:MARION
Middle Name:LOUISE
Last Name:CAVALLARO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BROOK LN
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-2807
Mailing Address - Country:US
Mailing Address - Phone:215-321-0133
Mailing Address - Fax:
Practice Address - Street 1:2000 PENNINGTON RD
Practice Address - Street 2:THE COLLEGE OF NEW JERSEY
Practice Address - City:EWING
Practice Address - State:NJ
Practice Address - Zip Code:08618-1104
Practice Address - Country:US
Practice Address - Phone:609-771-2406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00143400101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor