Provider Demographics
NPI:1912412040
Name:MARCELLE, CATHERINE SUSAN
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:SUSAN
Last Name:MARCELLE
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 1:391 VARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01854-2119
Mailing Address - Country:US
Mailing Address - Phone:978-455-3397
Mailing Address - Fax:978-459-9096
Practice Address - Street 1:391 VARNUM AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01854-2119
Practice Address - Country:US
Practice Address - Phone:978-455-3397
Practice Address - Fax:978-459-9096
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health