Provider Demographics
NPI:1285854091
Name:STAHR, MARY E (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:E
Last Name:STAHR
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 1:3657 CORTEZ RD W
Mailing Address - Street 2:SUITE 130
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34210-3106
Mailing Address - Country:US
Mailing Address - Phone:941-758-1636
Mailing Address - Fax:941-894-6224
Practice Address - Street 1:3657 CORTEZ RD W
Practice Address - Street 2:SUITE 130
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34210-3106
Practice Address - Country:US
Practice Address - Phone:941-758-1636
Practice Address - Fax:941-894-6224
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL12751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1655961OtherCIGNA
FL29909OtherAMERIGROUP VA
FL606701OtherAMERIHEALTH
FLZ2585OtherBCBS
FL0049888OtherGHI
FL29909OtherAMERIGROUP VA