MEDICARE: SUSAN MARIE MCCORD 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	149000121	IL
2	1041C0700X	Clinical Social Worker	LCSW-15447	AZ

General Provider Information

NPI Number	:	1245285329
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN MARIE MCCORD LCSW

Provider Business Mailing Address
First Line	:	1400 E SOUTHERN AVE
Second Line	:	SUITE 735
City	:	TEMPE
State	:	AZ
Zip	:	85282-5691
Country	:	US
Telephone Number	:	480-804-0326
Fax Number	:	480-302-7884

Provider Business Practice Location Address
First Line	:	2120 S MCCLINTOCK DR
Second Line	:	SUITE 105
City	:	TEMPE
State	:	AZ
Zip	:	85282-2692
Country	:	US
Telephone Number	:	480-804-0326
Fax Number	:	480-302-7884

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	06/03/2016

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