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Organization
MARY ELLEN STAHR LCSW LLC
Active
Organization
MARY ELLEN STAHR LCSW LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY ELLEN STAHR LCSW (OWNER)
(941) 758-1636
Entity
Organization
Contact information
Practice address
3653 CORTEZ RD W, SUITE 110 H, BRADENTON, FL 34210-3168
(941) 758-1636
(941) 894-6224
Mailing address
3653 CORTEZ RD W, SUITE 110 H, BRADENTON, FL 34210-3168
(941) 758-1636
(941) 894-6224
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1275
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004477465
AETNA
FL
05
—
001713800
—
FL
01
—
01128702
AMERIGROUP
FL
01
—
257481
MHN
FL
01
—
UAW065769
VALUE OPTIONS/MILITARY ONE SOURCE
FL
Enumeration date
04/23/2012
Last updated
01/27/2014
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