Provider Demographics
NPI:1265101166
Name:MARCELLUS, GRACE CHISONI (MSW)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:CHISONI
Last Name:MARCELLUS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:
Other - Last Name:SOLTAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:51 PASADENA PKWY
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1619
Mailing Address - Country:US
Mailing Address - Phone:781-854-6034
Mailing Address - Fax:
Practice Address - Street 1:255 PARK AVE STE 804
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1984
Practice Address - Country:US
Practice Address - Phone:781-854-6034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-13
Last Update Date:2021-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health