MEDICARE: MS. MARY AMANDA WHARTON 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
1	1041C0700X	Clinical Social Worker	DP02943348	WV

General Provider Information

NPI Number	:	1356775837
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY AMANDA WHARTON LICSW

Provider Business Mailing Address
First Line	:	354 GIVENS LN
Second Line	:
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-6549
Country	:	US
Telephone Number	:	304-268-4782
Fax Number	:

Provider Business Practice Location Address
First Line	:	354 GIVENS LN
Second Line	:
City	:	BERKELEY SPRINGS
State	:	WV
Zip	:	25411-6549
Country	:	US
Telephone Number	:	304-268-4782
Fax Number	:

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

Provider Enumeration Date	:	09/03/2013
Last Update Date	:	09/03/2013

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