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NPI Code Detail

MEDICARE: MARY WILLIAMS-KROGMAN LCSW

MEDICARE: MARY WILLIAMS-KROGMAN 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
11041C0700XClinical Social WorkerLC2120ME

General Provider Information

NPI Number : 1770545527
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY WILLIAMS-KROGMAN LCSW
Provider Business Mailing Address
First Line : 78 ATLANTIC PLACE
Second Line :
City : SOUTH PORTLAND
State : ME
Zip : 04106-2316
Country : US
Telephone Number : 207-842-7701
Fax Number : 207-842-7773
Provider Business Practice Location Address
First Line : 165 LANCASTER STREET
Second Line :
City : PORTLAND
State : ME
Zip : 04101-2406
Country : US
Telephone Number : 207-874-1030
Fax Number : 207-874-1044
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/06/2006
Last Update Date : 10/10/2012

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Directions to “ MARY WILLIAMS-KROGMAN LCSW” Practice Location

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