NPIMap

Individual provider Active NPI

Marcus Michael Marullo, MS, LAC, CCS, AADC

  • Addiction (Substance Use Disorder) Counselor
  • Breaux Bridge, LA
National Provider Identifier
1558958975
Registry record updated Dec 31, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
1014 Issued in LA
Practice address
648 Latiolais Dr
Breaux Bridge, LA 70517-4231
Phone
(337) 332-4878
Fax
(337) 332-4866
NPI assigned
Dec 31, 2020
Last updated
Dec 31, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X 1014 LA Primary

Addresses

Primary practice location

648 Latiolais Dr
Breaux Bridge, LA 70517-4231

Mailing address

648 Latiolais Dr
Breaux Bridge, LA 70517-4231
Phone (337) 332-4878

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
1014LAMDRegistered Dietitian

NPI Registry JSON

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

{
    "created_epoch": "1609372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609372800000",
    "number": "1558958975",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "648 LATIOLAIS DR",
            "city": "BREAUX BRIDGE",
            "state": "LA",
            "postal_code": "705174231",
            "telephone_number": "337-332-4878",
            "fax_number": "337-332-4866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "648 LATIOLAIS DR",
            "city": "BREAUX BRIDGE",
            "state": "LA",
            "postal_code": "705174231",
            "telephone_number": "337-332-4878",
            "fax_number": "337-332-4866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MARULLO",
        "first_name": "MARCUS",
        "middle_name": "MICHAEL",
        "name_prefix": "Mr.",
        "credential": "MS, LAC, CCS, AADC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-31",
        "last_updated": "2020-12-31",
        "certification_date": "2020-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "LA",
            "license": "1014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Breaux Bridge, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.