Marcel Tassara, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

3332 Issued in WI

Practice address

1032 S Cesar E Chavez Dr
Milwaukee, WI 53204-2203

Phone

(414) 672-1353

Fax

(414) 672-4265

NPI assigned

Sep 15, 2015

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

16TH Street Community Health Center Inc.Group PAC ID 6709876857, 83 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• 16TH Street Community Health Center Inc.

  • Federally Qualified Health Center (FQHC)
  • Milwaukee, WI
  • NPI 1417912999
  Medicare reassignment Care Compare group NPD
• Sixteenth Street Community Health Centers, Inc.

  • Federally Qualified Health Center (FQHC)
  • Milwaukee, WI
  • NPI 1649559642
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1442275200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745884800000",
    "number": "1265801740",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 778789",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606778789",
            "telephone_number": "414-672-1353"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1032 S CESAR E CHAVEZ DR",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532042203",
            "telephone_number": "414-672-1353",
            "fax_number": "414-672-4265"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5450 S Hately Ave",
            "address_purpose": "LOCATION",
            "city": "Cudahy",
            "state": "WI",
            "postal_code": "531102041",
            "country_code": "US",
            "telephone_number": "414-801-9596",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1635 W National Ave",
            "address_purpose": "LOCATION",
            "city": "Milwaukee",
            "state": "WI",
            "postal_code": "532041130",
            "country_code": "US",
            "telephone_number": "414-672-1353",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TASSARA",
        "first_name": "MARCEL",
        "name_prefix": "Mr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-15",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "WI",
            "license": "3332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Target Corporation
• Target Corporation and Subsidiaries
• Kevin Tarkington, CERTIFIED GRIEF EDUC
• Krista E Tarrien, CRNA
• Samantha Tartaglia, DPT
• J Channing Tassone, MD
• Anna Tatakis
• Teresa Michelle Tate-Simmons
• Taneisha Sherrie Tate
• Ufuk Tatli, DDS, PHD

• Clinical Psychologist in Milwaukee, WI
• Providers in Milwaukee, WI by specialty
• Clinical Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.