Provider Demographics
NPI:1366931172
Name:SANTIAGO-SERRANO, MARCELLE
Entity type:Individual
Prefix:
First Name:MARCELLE
Middle Name:
Last Name:SANTIAGO-SERRANO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1203 BROOK VIEW CIR
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-1654
Mailing Address - Country:US
Mailing Address - Phone:856-287-4700
Mailing Address - Fax:
Practice Address - Street 1:8001 ROOSEVELT BLVD STE 205
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-3010
Practice Address - Country:US
Practice Address - Phone:215-332-2311
Practice Address - Fax:215-332-1873
Is Sole Proprietor?:No
Enumeration Date:2018-05-07
Last Update Date:2018-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS018485103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist