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General NPI Number Information
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NPI Number | 1962769307
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Entity Type | Organization
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Legal Business Name | MARY ELLEN STAHR LCSW LLC
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 3653 CORTEZ RD W SUITE 110 H
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City | BRADENTON
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State | FL
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Zip | 34210-3168
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Country | US
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Telephone | 941-758-1636
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Fax | 941-894-6224
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Provider Business Mailing Address
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Address Line | 3653 CORTEZ RD W SUITE 110 H
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City | BRADENTON
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State | FL
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Zip | 34210-3168
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Country | US
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Telephone | 941-758-1636
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Fax | 941-894-6224
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Authorized Official
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Title or Position | OWNER
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Name | MARY ELLEN STAHR
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Credential | LCSW
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Telephone | 941-758-1636
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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 | 1275
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License Number State | FL
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