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NPI Code Detail

MEDICARE: MARY ALTA FEDDEMAN MSW, LCSWA

MEDICARE: MARY ALTA FEDDEMAN MSW, LCSWA
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
11041C0700XClinical Social WorkerP019220NC

General Provider Information

NPI Number : 1437836558
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ALTA FEDDEMAN MSW, LCSWA
Provider Business Mailing Address
First Line : 1735 GUESS RD
Second Line :
City : DURHAM
State : NC
Zip : 27701-1163
Country : US
Telephone Number : 919-360-4236
Fax Number :
Provider Business Practice Location Address
First Line : 1735 GUESS RD
Second Line :
City : DURHAM
State : NC
Zip : 27701-1163
Country : US
Telephone Number : 919-360-4236
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/30/2023
Last Update Date : 06/30/2023

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