MEDICARE: MRS. MARY PARKER LMSW

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	9499	SC

General Provider Information

NPI Number	:	1942652219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY PARKER LMSW

Provider Business Mailing Address
First Line	:	724 SHADOW MIST LN
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29210-5021
Country	:	US
Telephone Number	:	803-898-1663
Fax Number	:

Provider Business Practice Location Address
First Line	:	108 PALMETTO PARK BLVD STE D
Second Line	:
City	:	LEXINGTON
State	:	SC
Zip	:	29072-7969
Country	:	US
Telephone Number	:	803-359-7206
Fax Number	:

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

Provider Enumeration Date	:	07/11/2016
Last Update Date	:	07/11/2016

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