MEDICARE: MRS. MARION CHRISTINE ROSS L.C.S.W.

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	104100000X	Social Worker	C2287	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992709570
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARION CHRISTINE ROSS L.C.S.W.

Provider Business Mailing Address
First Line	:	133 EXECUTIVE DR STE A
Second Line	:
City	:	MADISON
State	:	MS
Zip	:	39110-8440
Country	:	US
Telephone Number	:	601-665-2047
Fax Number	:	800-476-4191

Provider Business Practice Location Address
First Line	:	133 EXECUTIVE DR STE A
Second Line	:
City	:	MADISON
State	:	MS
Zip	:	39110
Country	:	US
Telephone Number	:	601-665-2047
Fax Number	:	800-476-4191

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

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	07/13/2018

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