Healthcare Provider Details

I. General information

NPI: 1316166168
Provider Name (Legal Business Name): EVA MARON LISW-CP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1902 STATE ST STE B
CAYCE SC
29033-3955
US

IV. Provider business mailing address

1902 STATE ST STE B
CAYCE SC
29033-3955
US

V. Phone/Fax

Practice location:
  • Phone: 803-602-4369
  • Fax:
Mailing address:
  • Phone: 803-602-4369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberTPIC48
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15770
License Number StateSC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW009628
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34011683A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: