MEDICARE: DAVID MAROUCHOC LSW

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	CW020286	PA

General Provider Information

NPI Number	:	1851702799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MAROUCHOC LSW

Provider Business Mailing Address
First Line	:	803 CENTER ST
Second Line	:
City	:	JIM THORPE
State	:	PA
Zip	:	18229-2207
Country	:	US
Telephone Number	:	570-249-0228
Fax Number	:

Provider Business Practice Location Address
First Line	:	701 BRIDGE ST
Second Line	:	STE 206
City	:	LEHIGHTON
State	:	PA
Zip	:	18235-1800
Country	:	US
Telephone Number	:	570-249-0228
Fax Number	:

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

Provider Enumeration Date	:	05/14/2014
Last Update Date	:	01/15/2019

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Directions to “ DAVID MAROUCHOC LSW” Practice Location

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