Provider Demographics
NPI:1447376348
Name:LOGEL, MARVIN LEROY (PHD)
Entity type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:LEROY
Last Name:LOGEL
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 1:301 ALTARA AVE APT 519
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33146-1465
Mailing Address - Country:US
Mailing Address - Phone:952-221-7166
Mailing Address - Fax:952-937-0925
Practice Address - Street 1:5200 WILLSON RD STE 150
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55424-1300
Practice Address - Country:US
Practice Address - Phone:952-221-7166
Practice Address - Fax:952-937-0925
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP0569103T00000X, 103TP0814X, 103TC0700X
FLPY7902103T00000X, 103TC0700X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN10076LOOtherBLUE-CROSS BLUE-SHIELD