MEDICARE: MARY E STAHR 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	1275	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1655961	OTHER	FL	CIGNA
2	29909	OTHER	FL	AMERIGROUP VA
3	606701	OTHER	FL	AMERIHEALTH
4	Z2585	OTHER	FL	BCBS
5	0049888	OTHER	FL	GHI

General Provider Information

NPI Number	:	1285854091
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E STAHR LCSW

Provider Business Mailing Address
First Line	:	3657 CORTEZ RD W
Second Line	:	SUITE 130
City	:	BRADENTON
State	:	FL
Zip	:	34210-3106
Country	:	US
Telephone Number	:	941-758-1636
Fax Number	:	941-894-6224

Provider Business Practice Location Address
First Line	:	3657 CORTEZ RD W
Second Line	:	SUITE 130
City	:	BRADENTON
State	:	FL
Zip	:	34210-3106
Country	:	US
Telephone Number	:	941-758-1636
Fax Number	:	941-894-6224

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

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	03/07/2008

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Directions to “ MARY E STAHR LCSW” Practice Location

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