MEDICARE: MARY ANN CLENDENIN 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	1041C0700X	Clinical Social Worker	LC7363	ME
2	1041C0700X	Clinical Social Worker	LCSW-12846	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891764544
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY ANN CLENDENIN LCSW

Provider Business Mailing Address
First Line	:	PO BOX 188
Second Line	:
City	:	MARANA
State	:	AZ
Zip	:	85653-0188
Country	:	US
Telephone Number	:	520-682-4111
Fax Number	:

Provider Business Practice Location Address
First Line	:	899 N WILMOT RD STE B
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-1712
Country	:	US
Telephone Number	:	520-290-1100
Fax Number	:	520-290-8997

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

Provider Enumeration Date	:	03/15/2006
Last Update Date	:	01/09/2021

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Directions to “ MARY ANN CLENDENIN LCSW” Practice Location

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