MEDICARE: MS. MARILYN ELIZABETH BERNER 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	SW7387	FL

General Provider Information

NPI Number	:	1750399929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARILYN ELIZABETH BERNER LCSW

Provider Business Mailing Address
First Line	:	86 BAY DR
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040-6115
Country	:	US
Telephone Number	:	305-745-7294
Fax Number	:	305-745-7294

Provider Business Practice Location Address
First Line	:	1205 4TH ST
Second Line	:
City	:	KEY WEST
State	:	FL
Zip	:	33040-3707
Country	:	US
Telephone Number	:	305-292-6843
Fax Number	:	305-292-6723

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

Provider Enumeration Date	:	08/04/2006
Last Update Date	:	07/08/2007

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