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NPI Code Detail

MEDICARE: MARA LANE ANDERSON MA

MEDICARE: MARA LANE ANDERSON MA
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 WorkerLCSW-1882WY
2171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1629582457
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARA LANE ANDERSON MA
Provider Business Mailing Address
First Line : 900 S FOREST DR
Second Line :
City : CASPER
State : WY
Zip : 82609-2704
Country : US
Telephone Number : 307-672-8958
Fax Number :
Provider Business Practice Location Address
First Line : 900 S FOREST DR
Second Line :
City : CASPER
State : WY
Zip : 82609-2704
Country : US
Telephone Number : 307-217-1685
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2017
Last Update Date : 03/05/2026

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Directions to “ MARA LANE ANDERSON MA” Practice Location

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