MEDICARE: MARY CLEMENT 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	8164-C	NV

General Provider Information

NPI Number	:	1457987406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY CLEMENT LCSW

Provider Business Mailing Address
First Line	:	576 CICADA ST
Second Line	:
City	:	FALLON
State	:	NV
Zip	:	89406-4419
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 NEW RIVER PKWY
Second Line	:
City	:	FALLON
State	:	NV
Zip	:	89406-7802
Country	:	US
Telephone Number	:	775-867-7254
Fax Number	:

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

Provider Enumeration Date	:	03/20/2020
Last Update Date	:	03/20/2020

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