Healthcare Provider Details

I. General information

NPI: 1760188999
Provider Name (Legal Business Name): MARILYN S BOROM LCSW-A
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2023
Last Update Date: 07/14/2023
Certification Date: 07/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3770 SKYLAND DR
SYLVA NC
28779-8360
US

IV. Provider business mailing address

PO BOX 865
CULLOWHEE NC
28723-0865
US

V. Phone/Fax

Practice location:
  • Phone: 828-399-1395
  • Fax: 828-475-0400
Mailing address:
  • Phone: 828-399-1399
  • Fax: 828-475-0400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP019000
License Number StateNC

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: