MEDICARE: AMY M MAVY 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	101YM0800X	Mental Health Counselor	CSW 241	WY
2	1041C0700X	Clinical Social Worker	829	WY
3	171M00000X	Case Manager/Care Coordinator
4	1041C0700X	Clinical Social Worker	LCSW-1321	WY
5	1041C0700X	Clinical Social Worker	CSW 241	WY

General Provider Information

NPI Number	:	1942490792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY M MAVY LCSW

Provider Business Mailing Address
First Line	:	3923 HAYES AVE
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-2369
Country	:	US
Telephone Number	:	307-220-0862
Fax Number	:

Provider Business Practice Location Address
First Line	:	4025 RAWLINS ST
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82001-1900
Country	:	US
Telephone Number	:	307-426-4797
Fax Number	:

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

Provider Enumeration Date	:	07/27/2007
Last Update Date	:	09/09/2025

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