MEDICARE: MS. MARCIA JEAN GRACE MSW/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	104100000X	Social Worker	LCS 11033	CA

General Provider Information

NPI Number	:	1447492723
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARCIA JEAN GRACE MSW/LCSW

Provider Business Mailing Address
First Line	:	127 POMONA AVE.
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3428
Country	:	US
Telephone Number	:	562-883-1807
Fax Number	:	562-438-2658

Provider Business Practice Location Address
First Line	:	5855 NAPLES PLAZA
Second Line	:	#213
City	:	LONG BEACH
State	:	CA
Zip	:	90803-3428
Country	:	US
Telephone Number	:	562-883-1807
Fax Number	:	562-438-2658

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

Provider Enumeration Date	:	04/01/2009
Last Update Date	:	04/01/2009

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