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NPI Code Detail

MEDICARE: MS. MARY S DAUS LISW

MEDICARE: MS. MARY S DAUS LISW
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
1101YM0800XMental Health Counselor18423OH

General Provider Information

NPI Number : 1366428690
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. MARY S DAUS LISW
Provider Business Mailing Address
First Line : 640 W MARKET ST
Second Line :
City : AKRON
State : OH
Zip : 44303-1465
Country : US
Telephone Number : 330-762-5425
Fax Number : 330-762-4019
Provider Business Practice Location Address
First Line : 640 W MARKET ST
Second Line :
City : AKRON
State : OH
Zip : 44303-1413
Country : US
Telephone Number : 330-762-5425
Fax Number : 330-762-4019
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/19/2005
Last Update Date : 07/08/2007

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