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General NPI Number Information
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NPI Number | 1144272501
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Entity Type | Individual
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Provider Name | MARY N CONIGLIO LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 204 13TH ST
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City | PORT ST JOE
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State | FL
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Zip | 32456-2144
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Country | US
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Telephone | 850-340-3695
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Fax |
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Provider Business Mailing Address
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Address Line | 2739 JULIAN ST
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City | DECATUR
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State | GA
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Zip | 30032-3408
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Country | US
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Telephone | 404-372-3054
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW004120
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License Number State | GA
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