MEDICARE: COREY MUNROE

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	104100000X	Social Worker	119150	CA
2	1041C0700X	Clinical Social Worker	119150

General Provider Information

NPI Number	:	1124583513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COREY MUNROE

Provider Business Mailing Address
First Line	:	4415 SONOMA HWY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95409-7100
Country	:	US
Telephone Number	:	707-327-0909
Fax Number	:

Provider Business Practice Location Address
First Line	:	4415 SONOMA HWY
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95409-7100
Country	:	US
Telephone Number	:	707-327-0909
Fax Number	:

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

Provider Enumeration Date	:	02/10/2019
Last Update Date	:	09/06/2024

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Directions to “ COREY MUNROE ” Practice Location

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