Healthcare Provider Details

I. General information

NPI: 1407191711
Provider Name (Legal Business Name): MARY HUFF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2012
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

228 INDIAN CREEK RD
WYNNEWOOD PA
19096-3404
US

IV. Provider business mailing address

228 INDIAN CREEK RD
WYNNEWOOD PA
19096-3404
US

V. Phone/Fax

Practice location:
  • Phone: 302-650-2460
  • Fax:
Mailing address:
  • Phone: 302-650-2460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0001178
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW 017567
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: