MEDICARE: MARJORIE SHOCK 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	LCS16888	CA

General Provider Information

NPI Number	:	1811421969
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARJORIE SHOCK LCSW

Provider Business Mailing Address
First Line	:	1005 40TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3612
Country	:	US
Telephone Number	:	916-441-4138
Fax Number	:

Provider Business Practice Location Address
First Line	:	1005 40TH ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3612
Country	:	US
Telephone Number	:	916-441-4138
Fax Number	:

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

Provider Enumeration Date	:	04/16/2017
Last Update Date	:	04/16/2017

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