MEDICARE: MRS. MARCELLE LAROSE LCSW

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	1041C0700X	Clinical Social Worker	SW15455	FL

General Provider Information

NPI Number	:	1154913242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARCELLE LAROSE LCSW

Provider Business Mailing Address
First Line	:	100 MADRID ST
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1146
Country	:	US
Telephone Number	:	561-420-4072
Fax Number	:	561-328-9067

Provider Business Practice Location Address
First Line	:	100 MADRID ST
Second Line	:
City	:	ROYAL PALM BEACH
State	:	FL
Zip	:	33411-1146
Country	:	US
Telephone Number	:	561-420-4072
Fax Number	:	561-328-9067

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

Provider Enumeration Date	:	02/09/2021
Last Update Date	:	02/09/2021

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