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General NPI Number Information
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NPI Number | 1780643072
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Entity Type | Individual
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Provider Name | MARY B MOONEN MSW
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Gender | Female
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Dates
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Enumeration Date | 03/23/2006
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Last Update Date | 10/11/2011
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Provider Practice Location Address
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Address Line | 3653 CORTEZ ROAD WEST SUITE 110A
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City | BRADENTON
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State | FL
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Zip | 34210
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Country | US
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Telephone | 941-962-6784
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Fax | 941-753-8471
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Provider Business Mailing Address
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Address Line | 3653 CORTEZ ROAD WEST SUITE 110A
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City | BRADENTON
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State | FL
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Zip | 34210
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Country | US
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Telephone | 941-962-6784
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Fax | 941-753-8471
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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 | SW8791
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 3413
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License Number State | FL
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