Provider Demographics
NPI:1114085131
Name:HALL, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 N MARION ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-2638
Mailing Address - Country:US
Mailing Address - Phone:813-223-6830
Mailing Address - Fax:813-223-2522
Practice Address - Street 1:1613 N MARION ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33602-2638
Practice Address - Country:US
Practice Address - Phone:813-223-6830
Practice Address - Fax:813-223-2522
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool