MEDICARE: MS. MARIANNE HIPONA 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	1041C0700X	Clinical Social Worker	LCS 6884	CA

General Provider Information

NPI Number	:	1710953153
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARIANNE HIPONA MSW, LCSW

Provider Business Mailing Address
First Line	:	450 DONDEE ST
Second Line	:	SUITE 9 B
City	:	PACIFICA
State	:	CA
Zip	:	94044-3056
Country	:	US
Telephone Number	:	650-359-4326
Fax Number	:	650-359-4325

Provider Business Practice Location Address
First Line	:	450 DONDEE ST
Second Line	:	SUITE 9 B
City	:	PACIFICA
State	:	CA
Zip	:	94044-3056
Country	:	US
Telephone Number	:	650-359-4326
Fax Number	:	650-359-4325

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

Provider Enumeration Date	:	02/26/2006
Last Update Date	:	07/08/2007

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