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NPI Code Detail

MEDICARE: MARY LEE LCSW

MEDICARE: MARY LEE 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
11041C0700XClinical Social Worker1360CAL

General Provider Information

NPI Number : 1841568300
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LEE LCSW
Provider Business Mailing Address
First Line : 129 E PARK CIR
Second Line :
City : BIRMINGHAM
State : AL
Zip : 35235-3000
Country : US
Telephone Number : 205-836-7283
Fax Number : 205-836-9594
Provider Business Practice Location Address
First Line : 625 15TH ST N
Second Line :
City : PELL CITY
State : AL
Zip : 35125-1381
Country : US
Telephone Number : 205-338-7525
Fax Number : 205-836-9594
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2011
Last Update Date : 12/12/2011

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