MEDICARE: ROBERT L MARION LISW

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	I0700018	OH

General Provider Information

NPI Number	:	1538292651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT L MARION LISW

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	CHILLICOTHEE
State	:	OH
Zip	:	45601-0188
Country	:	US
Telephone Number	:	740-773-4366
Fax Number	:	740-775-7855

Provider Business Practice Location Address
First Line	:	2434 RICHMILLER LN UNIT F
Second Line	:
City	:	BELPRE
State	:	OH
Zip	:	45714-1075
Country	:	US
Telephone Number	:	740-423-8095
Fax Number	:	740-423-8096

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	11/06/2019

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