MEDICARE: MARY M MCCANN 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	991470	CO

General Provider Information

NPI Number	:	1316908528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY M MCCANN LCSW

Provider Business Mailing Address
First Line	:	9097 S BEAR MOUNTAIN DR
Second Line	:
City	:	HIGHLANDS RANCH
State	:	CO
Zip	:	80126-2272
Country	:	US
Telephone Number	:	303-683-4798
Fax Number	:	303-866-7481

Provider Business Practice Location Address
First Line	:	4055 S LOWELL BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80236-3120
Country	:	US
Telephone Number	:	303-866-7488
Fax Number	:	303-866-7481

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

Provider Enumeration Date	:	03/29/2006
Last Update Date	:	07/08/2007

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