MEDICARE: MARY WHALEN 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
1	1041C0700X	Clinical Social Worker	C002705	NC

General Provider Information

NPI Number	:	1275044828
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY WHALEN LCSW

Provider Business Mailing Address
First Line	:	22 CEDAR HILL DR
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-9382
Country	:	US
Telephone Number	:	19195993296
Fax Number	:

Provider Business Practice Location Address
First Line	:	2741 CAMPUS WALK AVE BUILDING 400
Second Line	:	SUITE 100
City	:	DURHAM
State	:	NC
Zip	:	27705-8878
Country	:	US
Telephone Number	:	984-888-5876
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/22/2017
Last Update Date	:	10/22/2017

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