MEDICARE: MARINA WESTPHAL 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	LCSW-17715	AZ
2	1041C0700X	Clinical Social Worker	SW16363CP	SC
3	1041C0700X	Clinical Social Worker	0904019583	VA

General Provider Information

NPI Number	:	1528609724
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARINA WESTPHAL LCSW

Provider Business Mailing Address
First Line	:	854 BIBURY CT
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29414-9120
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1483 TOBIAS GADSON BLVD
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29407-8702
Country	:	US
Telephone Number	:	843-876-5026
Fax Number	:

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

Provider Enumeration Date	:	09/30/2019
Last Update Date	:	06/03/2026

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