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NPI Code Detail

MEDICARE: MARY WHITE

MEDICARE: MARY WHITE
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 Worker15713FL

General Provider Information

NPI Number : 1881315257
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY WHITE
Provider Business Mailing Address
First Line : 5413 PORTOLA AVE
Second Line :
City : NEW PORT RICHEY
State : FL
Zip : 34652-5420
Country : US
Telephone Number : 813-367-6929
Fax Number :
Provider Business Practice Location Address
First Line : 13000 BRUCE B DOWNS BLVD
Second Line :
City : TAMPA
State : FL
Zip : 33612-4745
Country : US
Telephone Number : 813-367-6929
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2022
Last Update Date : 09/06/2022

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Directions to “ MARY WHITE ” Practice Location

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