MEDICARE: MS. MARY ULRIKSEN BRIGHT 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	SW0004060	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972608800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ULRIKSEN BRIGHT LCSW

Provider Business Mailing Address
First Line	:	2513 W HILLSBOROUGH AVE STE 210
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-6122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2513 W HILLSBOROUGH AVE STE 210
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33614-6122
Country	:	US
Telephone Number	:	813-450-1052
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	08/13/2024

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