MEDICARE: MARJORIE DEWALD 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	LCSW-2863	AZ

General Provider Information

NPI Number	:	1285065177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARJORIE DEWALD LCSW

Provider Business Mailing Address
First Line	:	11725 E CALLE DE SAMUEL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85749-9509
Country	:	US
Telephone Number	:	520-248-2709
Fax Number	:

Provider Business Practice Location Address
First Line	:	11725 E CALLE DE SAMUEL
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85749-9509
Country	:	US
Telephone Number	:	520-248-2709
Fax Number	:

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

Provider Enumeration Date	:	12/03/2013
Last Update Date	:	02/18/2026

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