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NPI Code Detail

MEDICARE: MARY J HARRELL LCSW

MEDICARE: MARY J HARRELL LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker34003719AIN

General Provider Information

NPI Number : 1083890925
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY J HARRELL LCSW
Provider Business Mailing Address
First Line : 850 N HARRISON ST
Second Line : ATTN: ANNE LAWSON
City : WARSAW
State : IN
Zip : 46580-3163
Country : US
Telephone Number : 574-267-7169
Fax Number : 574-269-3995
Provider Business Practice Location Address
First Line : 255 N MIAMI ST
Second Line :
City : WABASH
State : IN
Zip : 46992-2705
Country : US
Telephone Number : 260-563-8446
Fax Number : 260-563-1902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2008
Last Update Date : 01/10/2008

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