MEDICARE: MRS. KARA THERESA MARRIOTT LICSW

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	15027	MN

General Provider Information

NPI Number	:	1841460458
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KARA THERESA MARRIOTT LICSW

Provider Business Mailing Address
First Line	:	1620 CHARLTON STREET #212
Second Line	:
City	:	WEST ST. PAUL
State	:	MN
Zip	:	55118
Country	:	US
Telephone Number	:	651-402-3537
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 CHARLTON STREET #212
Second Line	:
City	:	WEST ST. PAUL
State	:	MN
Zip	:	55118
Country	:	US
Telephone Number	:	651-402-3537
Fax Number	:

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

Provider Enumeration Date	:	03/11/2008
Last Update Date	:	02/22/2010

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Directions to “ MRS. KARA THERESA MARRIOTT LICSW” Practice Location

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