Provider Demographics
NPI:1952830648
Name:MOCK, MARJORIE S (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARJORIE
Middle Name:S
Last Name:MOCK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARGIE
Other - Middle Name:S
Other - Last Name:MOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3102 WEST END AVE
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1324
Mailing Address - Country:US
Mailing Address - Phone:505-254-4500
Mailing Address - Fax:505-266-0838
Practice Address - Street 1:5400 GIBSON BLVD SE
Practice Address - Street 2:4TH FLOOR
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4729
Practice Address - Country:US
Practice Address - Phone:505-254-4500
Practice Address - Fax:505-266-0838
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C-06896104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker