=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982954012
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARY ALICE FUHRER LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/17/2012
-----------------------------------------------------
Last Update Date | 09/17/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1025 N VICTOR II BLVD SUITE S, ROOM 109
-----------------------------------------------------
City | MORGAN CITY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70380-1349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-714-4413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1025 N VICTOR II BLVD SUITE S, ROOM 109
-----------------------------------------------------
City | MORGAN CITY
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70380-1349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 985-714-4413
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 8919
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------