MEDICARE: MARY E MOREL M.A., 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	SW2722	FL

General Provider Information

NPI Number	:	1669544185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY E MOREL M.A., LCSW

Provider Business Mailing Address
First Line	:	10225 ULMERTON RD 8B
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33771-3522
Country	:	US
Telephone Number	:	727-586-0636
Fax Number	:	727-585-6287

Provider Business Practice Location Address
First Line	:	10225 ULMERTON RD STE 8B
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33771-3522
Country	:	US
Telephone Number	:	727-586-0636
Fax Number	:	727-585-6287

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	10/22/2011

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