MEDICARE: MS. MARION VICTORIA MCCULLEY 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	992420	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1922037233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARION VICTORIA MCCULLEY LCSW

Provider Business Mailing Address
First Line	:	1223 HUMBOLDT ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80218-2413
Country	:	US
Telephone Number	:	303-819-2431
Fax Number	:	720-956-2313

Provider Business Practice Location Address
First Line	:	1650 WASHINGTON ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80203-1407
Country	:	US
Telephone Number	:	303-819-2431
Fax Number	:	720-956-2313

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

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	08/13/2007

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