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General NPI Number Information
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NPI Number | 1851671101
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Entity Type | Individual
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Provider Name | MARYGRACE OHEARN LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/18/2011
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Last Update Date | 08/18/2011
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Provider Practice Location Address
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Address Line | 6339 SW 42ND TERRACE
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City | SOUTH MIAMI
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State | FL
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Zip | 33155
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Country | US
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Telephone | 305-323-3799
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Fax |
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Provider Business Mailing Address
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Address Line | 7600 RED RD 215
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City | SOUTH MIAMI
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State | FL
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Zip | 33143-5428
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Country | US
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Telephone | 305-323-3799
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Fax | 305-668-3146
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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 | SW10292
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License Number State | FL
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