Healthcare Provider Details

I. General information

NPI: 1598041600
Provider Name (Legal Business Name): JEAN MARION MCSORLEY M.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2011
Last Update Date: 05/26/2021
Certification Date: 05/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 JOHN JONES RD
DAVIS CA
95616-9701
US

IV. Provider business mailing address

2051 JOHN JONES RD
DAVIS CA
95616-9701
US

V. Phone/Fax

Practice location:
  • Phone: 530-758-2060
  • Fax: 530-758-8490
Mailing address:
  • Phone: 307-582-0605
  • Fax: 530-758-8494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW66535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: