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NPI Code Detail

MEDICARE: MARY ELIZABETH STATEN

MEDICARE: MARY ELIZABETH STATEN
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
1171M00000XCase Manager/Care Coordinator
2101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1831671759
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELIZABETH STATEN
Provider Business Mailing Address
First Line : 600 WAYNE AVE
Second Line :
City : DAYTON
State : OH
Zip : 45410-1122
Country : US
Telephone Number : 937-469-2000
Fax Number :
Provider Business Practice Location Address
First Line : 600 WAYNE AVE
Second Line :
City : DAYTON
State : OH
Zip : 45410-1122
Country : US
Telephone Number : 937-496-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2018
Last Update Date : 02/24/2026

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Directions to “ MARY ELIZABETH STATEN ” Practice Location

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