MEDICARE: MARY LEN I 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	082066-1	NY
2	1041C0700X	Clinical Social Worker	SW16757	FL

General Provider Information

NPI Number	:	1407265226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LEN I LCSW

Provider Business Mailing Address
First Line	:	1500 LAKE BUFFUM RD E
Second Line	:
City	:	FORT MEADE
State	:	FL
Zip	:	33841-9560
Country	:	US
Telephone Number	:	716-472-0306
Fax Number	:

Provider Business Practice Location Address
First Line	:	1500 LAKE BUFFUM RD E
Second Line	:
City	:	FORT MEADE
State	:	FL
Zip	:	33841-9560
Country	:	US
Telephone Number	:	716-472-0306
Fax Number	:

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

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	01/02/2025

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Directions to “ MARY LEN I LCSW” Practice Location

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