MEDICARE: ROBERT L. MARRS, L.C.S.W., P.C.

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	1179	OR

General Provider Information

NPI Number	:	1295063717
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERT L. MARRS, L.C.S.W., P.C.

Provider Business Mailing Address
First Line	:	7175 SW BEVELAND RD
Second Line	:	SUITE 105
City	:	TIGARD
State	:	OR
Zip	:	97223-8665
Country	:	US
Telephone Number	:	503-620-5455
Fax Number	:

Provider Business Practice Location Address
First Line	:	7175 SW BEVELAND RD
Second Line	:	SUITE 105
City	:	TIGARD
State	:	OR
Zip	:	97223-8665
Country	:	US
Telephone Number	:	503-620-5455
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL SOCIAL WORKER
Name	:	MR. ROBERT L. MARRS
Credential	:	L.C.S.W.
Telephone Number	:	503-620-5455

Provider Enumeration Date	:	11/20/2009
Last Update Date	:	11/20/2009

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