Healthcare Provider Details

I. General information

NPI: 1669544185
Provider Name (Legal Business Name): MARY E MOREL M.A., LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 10/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10225 ULMERTON RD STE 8B
LARGO FL
33771-3522
US

IV. Provider business mailing address

10225 ULMERTON RD 8B
LARGO FL
33771-3522
US

V. Phone/Fax

Practice location:
  • Phone: 727-586-0636
  • Fax: 727-585-6287
Mailing address:
  • Phone: 727-586-0636
  • Fax: 727-585-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW2722
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: