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NPI Code Detail

MEDICARE: MRS. MARIN C BYWATER LCSW

MEDICARE: MRS. MARIN C BYWATER 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
11041C0700XClinical Social Worker59200653502UT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1INTERNOTHERUTDESERET MUTUAL
2INTERNOTHERUTINTRMTN. HEALTH CARE

General Provider Information

NPI Number : 1437138807
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. MARIN C BYWATER LCSW
Provider Business Mailing Address
First Line : 780 GUARDSMAN WAY
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-1374
Country : US
Telephone Number : 801-581-0194
Fax Number : 801-581-0193
Provider Business Practice Location Address
First Line : 780 GUARDSMAN WAY
Second Line :
City : SALT LAKE CITY
State : UT
Zip : 84108-1374
Country : US
Telephone Number : 801-581-0194
Fax Number : 801-581-0193
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2006
Last Update Date : 03/06/2013

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Directions to “ MRS. MARIN C BYWATER LCSW” Practice Location

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