MEDICARE: MARILYN SEARS 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	1041C0700X	Clinical Social Worker	LCSW1080	ID

General Provider Information

NPI Number	:	1518166701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARILYN SEARS LCSW

Provider Business Mailing Address
First Line	:	9458 W FAIRVIEW AVE STE J
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-9785
Country	:	US
Telephone Number	:	208-713-8070
Fax Number	:	208-362-2010

Provider Business Practice Location Address
First Line	:	9458 W FAIRVIEW AVE STE J
Second Line	:
City	:	BOISE
State	:	ID
Zip	:	83704-9785
Country	:	US
Telephone Number	:	208-713-8070
Fax Number	:	208-362-2010

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

Provider Enumeration Date	:	07/17/2007
Last Update Date	:	07/17/2007

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Directions to “ MARILYN SEARS LCSW” Practice Location

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