MEDICARE: MS. CAROL MARGARET SCHUBECK 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	101YA0400X	Addiction (Substance Use Disorder) Counselor	15933	CA
2	101YM0800X	Mental Health Counselor	15933	CA
3	104100000X	Social Worker	LCS#15933	CA

General Provider Information

NPI Number	:	1568455186
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL MARGARET SCHUBECK LCSW

Provider Business Mailing Address
First Line	:	12625 N GENTLE RAIN DR
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85658-4394
Country	:	US
Telephone Number	:	520-222-2012
Fax Number	:

Provider Business Practice Location Address
First Line	:	12625 N GENTLE RAIN DR
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85658-4394
Country	:	US
Telephone Number	:	520-222-2012
Fax Number	:

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

Provider Enumeration Date	:	08/30/2005
Last Update Date	:	12/29/2011

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