MEDICARE: MS. MARY F BAER 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	004424	GA
2	1041C0700X	Clinical Social Worker	CSW004424	GA

General Provider Information

NPI Number	:	1811173651
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY F BAER LCSW

Provider Business Mailing Address
First Line	:	1301 SHILOH RD NW STE 450
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144-7152
Country	:	US
Telephone Number	:	404-426-3453
Fax Number	:

Provider Business Practice Location Address
First Line	:	1301 SHILOH RD NW STE 450
Second Line	:
City	:	KENNESAW
State	:	GA
Zip	:	30144
Country	:	US
Telephone Number	:	404-426-3453
Fax Number	:

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

Provider Enumeration Date	:	01/10/2008
Last Update Date	:	07/10/2018

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