MEDICARE: MRS. RUTHMARY B MCVAY LICSW

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	11343	MN

General Provider Information

NPI Number	:	1083740773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RUTHMARY B MCVAY LICSW

Provider Business Mailing Address
First Line	:	1800 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-1901
Country	:	US
Telephone Number	:	612-879-3324
Fax Number	:	612-879-3390

Provider Business Practice Location Address
First Line	:	1800 CHICAGO AVE
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55404-1901
Country	:	US
Telephone Number	:	612-879-3324
Fax Number	:	612-879-3390

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

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/08/2007

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