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NPI Code Detail

MEDICARE: MARIAH KRISTINE MCANDREW MSW, LICSW

MEDICARE: MARIAH KRISTINE MCANDREW MSW, LICSW
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 Worker5655ND
21041C0700XClinical Social Worker29688MN

General Provider Information

NPI Number : 1184185266
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARIAH KRISTINE MCANDREW MSW, LICSW
Provider Business Mailing Address
First Line : 1401 EAST 1ST STREET
Second Line :
City : DULUTH
State : MN
Zip : 55805-2407
Country : US
Telephone Number : 218-728-4491
Fax Number : 218-302-8698
Provider Business Practice Location Address
First Line : 120 W 2ND ST
Second Line :
City : DULUTH
State : MN
Zip : 55802-2017
Country : US
Telephone Number : 218-728-4491
Fax Number : 218-302-8698
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2019
Last Update Date : 09/14/2023

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