MEDICARE: MARYANNE ELIZABETH WHITE 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	104100000X	Social Worker	SW137408	PA
2	1041C0700X	Clinical Social Worker	CW024697	PA

General Provider Information

NPI Number	:	1619651858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANNE ELIZABETH WHITE LCSW

Provider Business Mailing Address
First Line	:	371 N MAIN ST
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16001-4955
Country	:	US
Telephone Number	:	724-355-1111
Fax Number	:

Provider Business Practice Location Address
First Line	:	371 N MAIN ST
Second Line	:
City	:	BUTLER
State	:	PA
Zip	:	16001-4955
Country	:	US
Telephone Number	:	724-355-1111
Fax Number	:

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

Provider Enumeration Date	:	06/08/2023
Last Update Date	:	07/08/2024

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