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NPI Code Detail

MEDICARE: STEPHANIE MAUK MSW, LGSW

MEDICARE: STEPHANIE MAUK MSW, LGSW
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
1104100000XSocial WorkerBP00944911WV

General Provider Information

NPI Number : 1457944548
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE MAUK MSW, LGSW
Provider Business Mailing Address
First Line : PO BOX 474
Second Line :
City : CEREDO
State : WV
Zip : 25507-0474
Country : US
Telephone Number : 606-207-2741
Fax Number :
Provider Business Practice Location Address
First Line : 1596 WASHINGTON BLVD
Second Line :
City : HUNTINGTON
State : WV
Zip : 25701-4035
Country : US
Telephone Number : 606-207-2741
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2021
Last Update Date : 02/19/2021

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