MEDICARE: MARY N CONIGLIO 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	CSW004120	GA

General Provider Information

NPI Number	:	1144272501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY N CONIGLIO LCSW

Provider Business Mailing Address
First Line	:	2739 JULIAN ST
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30032-3408
Country	:	US
Telephone Number	:	404-372-3054
Fax Number	:

Provider Business Practice Location Address
First Line	:	204 13TH ST
Second Line	:
City	:	PORT ST JOE
State	:	FL
Zip	:	32456-2144
Country	:	US
Telephone Number	:	850-340-3695
Fax Number	:

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	12/01/2025

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