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NPI Code Detail

MEDICARE: MS. MARY ELIZABETH STANFORD PICKER MSW, LCSW

MEDICARE: MS. MARY ELIZABETH STANFORD PICKER MSW, 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
1104100000XSocial WorkerC018146NC

General Provider Information

NPI Number : 1164155222
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY ELIZABETH STANFORD PICKER MSW, LCSW
Provider Business Mailing Address
First Line : 2629 BATHGATE LN
Second Line :
City : MATTHEWS
State : NC
Zip : 28105-2348
Country : US
Telephone Number : 501-590-4753
Fax Number :
Provider Business Practice Location Address
First Line : 6900 FARMINGDALE DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28212-5551
Country : US
Telephone Number : 704-910-5810
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/06/2022
Last Update Date : 02/19/2025

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