Provider Demographics
NPI:1033634548
Name:METCALF, MARY MONICA (LSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MONICA
Last Name:METCALF
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4907 W SOUTH RANGE RD
Mailing Address - Street 2:
Mailing Address - City:CANFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44406-9476
Mailing Address - Country:US
Mailing Address - Phone:234-759-3332
Mailing Address - Fax:
Practice Address - Street 1:4907 W SOUTH RANGE RD
Practice Address - Street 2:
Practice Address - City:CANFIELD
Practice Address - State:OH
Practice Address - Zip Code:44406-9476
Practice Address - Country:US
Practice Address - Phone:234-759-3332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS0006852104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker