MEDICARE: MRS. MARY B ABLETT 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	39014	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	87618Q	OTHER	TX	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1902955727
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY B ABLETT LCSW

Provider Business Mailing Address
First Line	:	183 FOREST BEND LN
Second Line	:
City	:	WEATHERFORD
State	:	TX
Zip	:	76087-3604
Country	:	US
Telephone Number	:	817-598-0345
Fax Number	:	817-598-9169

Provider Business Practice Location Address
First Line	:	7833 OAKMONT BLVD
Second Line	:	110
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4204
Country	:	US
Telephone Number	:	817-665-0583
Fax Number	:	817-370-8977

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

Provider Enumeration Date	:	01/10/2007
Last Update Date	:	07/08/2007

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