=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215478680
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARY-ELIZABETH ADAMSON, LCSW LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/17/2017
-----------------------------------------------------
Last Update Date | 06/27/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1774 SEA LARK LN
-----------------------------------------------------
City | NAVARRE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32566-7472
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-684-1901
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6274 HERONWALK DR
-----------------------------------------------------
City | GULF BREEZE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32563-7034
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-375-1562
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. MARY-ELIZABETH ADAMSON
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 850-375-1562
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | SW 12693
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------