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NPI Code Detail

MEDICARE: MARY ELIZABETH GARDNER MSW, LCSWA

MEDICARE: MARY ELIZABETH GARDNER MSW, LCSWA
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 WorkerP020592NC

General Provider Information

NPI Number : 1750122719
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELIZABETH GARDNER MSW, LCSWA
Provider Business Mailing Address
First Line : 5510 SIX FORKS RD STE 125
Second Line :
City : RALEIGH
State : NC
Zip : 27609-3884
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5510 SIX FORKS RD STE 125
Second Line :
City : RALEIGH
State : NC
Zip : 27609-3884
Country : US
Telephone Number : 919-861-4111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/04/2024
Last Update Date : 06/04/2024

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