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General NPI Number Information
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NPI Number | 1265601504
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Entity Type | Individual
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Provider Name | MS. MARY T WHITE
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Gender | Female
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Dates
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Enumeration Date | 02/20/2008
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Last Update Date | 12/31/2008
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Provider Practice Location Address
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Address Line | 68 EXCHANGE ST W
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City | SAINT PAUL
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State | MN
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Zip | 55102-1006
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Country | US
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Telephone | 651-222-4373
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Fax | 651-777-4442
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Provider Business Mailing Address
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Address Line | 2675 LARPENTEUR AVE E
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City | SAINT PAUL
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State | MN
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Zip | 55109-5003
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Country | US
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Telephone | 651-777-8181
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Fax | 651-777-4442
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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 | 04268
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License Number State | MN
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