Provider Demographics
NPI:1538629506
Name:MARCELLON, SANDIA (LCSW)
Entity type:Individual
Prefix:MISS
First Name:SANDIA
Middle Name:
Last Name:MARCELLON
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 1:1324 NW 5TH AVE APT 2
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-6052
Mailing Address - Country:US
Mailing Address - Phone:549-380-0559
Mailing Address - Fax:
Practice Address - Street 1:1324 NW 5TH AVE APT 2
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33311-6052
Practice Address - Country:US
Practice Address - Phone:549-380-0559
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-25
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW161391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical