MEDICARE: MARY DEVLIN-MCKAY 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	11475	MT

General Provider Information

NPI Number	:	1760876957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY DEVLIN-MCKAY LCSW

Provider Business Mailing Address
First Line	:	401 OAK ST
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-2323
Country	:	US
Telephone Number	:	443-223-6358
Fax Number	:

Provider Business Practice Location Address
First Line	:	1018 BURLINGTON AVE STE 206
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59801-5666
Country	:	US
Telephone Number	:	443-223-6358
Fax Number	:

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

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	06/14/2019

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