Healthcare Provider Details

I. General information

NPI: 1790334209
Provider Name (Legal Business Name): MARY ANNA CAROLINE GIVEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2019
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15944 AUTUMN GLEN AVE
CLERMONT FL
34714-6109
US

IV. Provider business mailing address

15944 AUTUMN GLEN AVE
CLERMONT FL
34714-6109
US

V. Phone/Fax

Practice location:
  • Phone: 386-212-4426
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW16738
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: