Provider Demographics
NPI:1689066847
Name:ARNOLD, MARY (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:ARNOLD
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 1:482D MEDICAL SQUADRON
Mailing Address - Street 2:12749 ELMENDORF ST BLDG 347
Mailing Address - City:HOMESTEAD AFB
Mailing Address - State:FL
Mailing Address - Zip Code:33039-0001
Mailing Address - Country:US
Mailing Address - Phone:786-415-7615
Mailing Address - Fax:
Practice Address - Street 1:482D MEDICAL SQUADRON
Practice Address - Street 2:12749 ELMENDORF ST BLDG 347
Practice Address - City:HOMESTEAD AFB
Practice Address - State:FL
Practice Address - Zip Code:33039-0001
Practice Address - Country:US
Practice Address - Phone:786-415-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-25
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW231221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical