MEDICARE: MARY ELIZABETH MARRONE MSW, ACSW

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		CA
2	104100000X	Social Worker	ASW81483	CA

General Provider Information

NPI Number	:	1063990349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ELIZABETH MARRONE MSW, ACSW

Provider Business Mailing Address
First Line	:	15230 EARLHAM ST
Second Line	:
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-4341
Country	:	US
Telephone Number	:	310-570-3421
Fax Number	:

Provider Business Practice Location Address
First Line	:	1055 E COLORADO BLVD
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91106-2327
Country	:	US
Telephone Number	:	661-402-1545
Fax Number	:

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

Provider Enumeration Date	:	07/30/2018
Last Update Date	:	07/30/2018

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