Provider Demographics
NPI:1366485278
Name:MARCELLO, ROBERT (PHD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:MARCELLO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 N PARHAM RD STE 5
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-3171
Mailing Address - Country:US
Mailing Address - Phone:804-270-1124
Mailing Address - Fax:804-270-2070
Practice Address - Street 1:2301 N PARHAM RD
Practice Address - Street 2:
Practice Address - City:HENRICO
Practice Address - State:VA
Practice Address - Zip Code:23229-3171
Practice Address - Country:US
Practice Address - Phone:804-270-1124
Practice Address - Fax:804-270-2070
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001795103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA192478OtherBLUE CROSS
VA010259266Medicaid
VA010042C90Medicare PIN