MEDICARE: MISS MADELYN MARGARET SCARBERRY LISW-S

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	0009997	OH

General Provider Information

NPI Number	:	1912201997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MADELYN MARGARET SCARBERRY LISW-S

Provider Business Mailing Address
First Line	:	6500 BUSCH BLVD STE 120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-1738
Country	:	US
Telephone Number	:	614-827-6511
Fax Number	:	614-396-7090

Provider Business Practice Location Address
First Line	:	6500 BUSCH BLVD STE 120
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43229-1738
Country	:	US
Telephone Number	:	614-827-6511
Fax Number	:	614-396-7090

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

Provider Enumeration Date	:	01/05/2011
Last Update Date	:	02/07/2017

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