MEDICARE: IRMELA GRACE MACEWEN MSW, LCSW-C

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	11117	MD

General Provider Information

NPI Number	:	1588965198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRMELA GRACE MACEWEN MSW, LCSW-C

Provider Business Mailing Address
First Line	:	164 W MAIN ST STE A
Second Line	:	P.O. BOX 277
City	:	NEW MARKET
State	:	MD
Zip	:	21774-6279
Country	:	US
Telephone Number	:	301-865-2226
Fax Number	:	301-865-6720

Provider Business Practice Location Address
First Line	:	164 W MAIN ST STE A
Second Line	:
City	:	NEW MARKET
State	:	MD
Zip	:	21774-6279
Country	:	US
Telephone Number	:	301-865-2226
Fax Number	:	301-865-6720

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

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	12/10/2021

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