MEDICARE: MRS. MARY KATE MCVEIGH COUNSELOR A&D

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	011513	MD

General Provider Information

NPI Number	:	1659411130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY KATE MCVEIGH COUNSELOR A&D

Provider Business Mailing Address
First Line	:	2941 BRADENBAUGH RD
Second Line	:
City	:	WHITE HALL
State	:	MD
Zip	:	21161-9635
Country	:	US
Telephone Number	:	410-557-6382
Fax Number	:

Provider Business Practice Location Address
First Line	:	2941 BRADENBAUGH RD
Second Line	:
City	:	WHITE HALL
State	:	MD
Zip	:	21161-9635
Country	:	US
Telephone Number	:	410-557-6382
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	07/08/2007

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