MEDICARE: MARY MCGREEN M.S.ED. ED.S

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	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1821480252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY MCGREEN M.S.ED. ED.S

Provider Business Mailing Address
First Line	:	1449 DAVIS
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1449 DAVIS DR
Second Line	:
City	:	FORT MYERS
State	:	FL
Zip	:	33919-1007
Country	:	US
Telephone Number	:	239-555-1212
Fax Number	:

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

Provider Enumeration Date	:	02/23/2015
Last Update Date	:	06/17/2015

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