MEDICARE: MARCIE GIBBS SOCIAL WORKER

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

General Provider Information

NPI Number	:	1447329917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCIE GIBBS SOCIAL WORKER

Provider Business Mailing Address
First Line	:	631 MAPLE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90014-2211
Country	:	US
Telephone Number	:	213-680-6366
Fax Number	:

Provider Business Practice Location Address
First Line	:	631 MAPLE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90014-2211
Country	:	US
Telephone Number	:	213-680-6366
Fax Number	:

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

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	12/07/2020

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Directions to “ MARCIE GIBBS SOCIAL WORKER” Practice Location

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