MEDICARE: MARIAN B TAYLOR 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	11652815-3501	UT

General Provider Information

NPI Number	:	1720697055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARIAN B TAYLOR LCSW

Provider Business Mailing Address
First Line	:	3311 N UNIVERSITY AVE STE 275
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-7407
Country	:	US
Telephone Number	:	650-799-9903
Fax Number	:

Provider Business Practice Location Address
First Line	:	3311 N UNIVERSITY AVE STE 275
Second Line	:
City	:	PROVO
State	:	UT
Zip	:	84604-7407
Country	:	US
Telephone Number	:	650-799-9903
Fax Number	:

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

Provider Enumeration Date	:	07/22/2020
Last Update Date	:	02/10/2026

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