MEDICARE: MARY V WHITE MSW 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	SW1847	FL

General Provider Information

NPI Number	:	1962507962
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY V WHITE MSW LCSW

Provider Business Mailing Address
First Line	:	3530 1ST AVE N
Second Line	:	STE 121
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-8441
Country	:	US
Telephone Number	:	727-321-5011
Fax Number	:

Provider Business Practice Location Address
First Line	:	3530 1ST AVE N
Second Line	:	STE 121
City	:	ST PETERSBURG
State	:	FL
Zip	:	33713-8441
Country	:	US
Telephone Number	:	727-321-5011
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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