MEDICARE: FELICIA MAROHN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	C-08853	NM

General Provider Information

NPI Number	:	1083964613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELICIA MAROHN LCSW

Provider Business Mailing Address
First Line	:	411 SAINT MICHAELS DR
Second Line	:	SUITE 2
City	:	SANTA FE
State	:	NM
Zip	:	87505-7655
Country	:	US
Telephone Number	:	505-231-0035
Fax Number	:	505-982-2196

Provider Business Practice Location Address
First Line	:	411 SAINT MICHAELS DR
Second Line	:	SUITE 2
City	:	SANTA FE
State	:	NM
Zip	:	87505-7655
Country	:	US
Telephone Number	:	505-231-0035
Fax Number	:	505-982-2196

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2012
Last Update Date	:	01/04/2016

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