Provider Demographics
NPI:1104016245
Name:CARAWAY, MARY KAREN (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KAREN
Last Name:CARAWAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:LIBBY
Mailing Address - State:MT
Mailing Address - Zip Code:59923-1821
Mailing Address - Country:US
Mailing Address - Phone:406-293-2763
Mailing Address - Fax:406-494-1724
Practice Address - Street 1:101 SKI RD
Practice Address - Street 2:
Practice Address - City:LIBBY
Practice Address - State:MT
Practice Address - Zip Code:59923-2843
Practice Address - Country:US
Practice Address - Phone:406-293-2763
Practice Address - Fax:406-494-1724
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT5921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT592OtherSTATE OF MONTANA LICENSE