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NPI Code Detail

MEDICARE: MS. MARILYN FAYE BASS LCSW

MEDICARE:  MS. MARILYN FAYE BASS  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 WorkerSW000341MO

General Provider Information

NPI Number : 1497748578
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARILYN FAYE BASS LCSW
Provider Business Mailing Address
First Line : 802 VILLETTE CT
Second Line :
City : BALLWIN
State : MO
Zip : 63011-4142
Country : US
Telephone Number : 636-256-2990
Fax Number : 636-256-2990
Provider Business Practice Location Address
First Line : 802 VILLETTE CT
Second Line :
City : BALLWIN
State : MO
Zip : 63011-4142
Country : US
Telephone Number : 636-256-2990
Fax Number : 636-256-2990
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 07/08/2007

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Directions to “ MS. MARILYN FAYE BASS LCSW” Practice Location

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