MEDICARE: MARY ANNE MILLARE WENCESLAO LCSW, LCDC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	10883	TX
2	1041C0700X	Clinical Social Worker	51086	TX

General Provider Information

NPI Number	:	1427236876
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANNE MILLARE WENCESLAO LCSW, LCDC

Provider Business Mailing Address
First Line	:	926 WITHERBY LN
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-4477
Country	:	US
Telephone Number	:	888-317-7021
Fax Number	:

Provider Business Practice Location Address
First Line	:	926 WITHERBY LN
Second Line	:
City	:	LEWISVILLE
State	:	TX
Zip	:	75067-4477
Country	:	US
Telephone Number	:	888-317-7021
Fax Number	:

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

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	03/09/2026

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