MEDICARE: MS. CAROLE JEAN MARCUS 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	LCS5536	CA

General Provider Information

NPI Number	:	1730298415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROLE JEAN MARCUS LCSW

Provider Business Mailing Address
First Line	:	334 RIDGEWOOD AVE
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-3440
Country	:	US
Telephone Number	:	415-474-9677
Fax Number	:	415-381-2939

Provider Business Practice Location Address
First Line	:	3403 SACRAMENTO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1913
Country	:	US
Telephone Number	:	415-474-9644
Fax Number	:	415-381-2939

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

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	07/08/2007

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