Provider Demographics
NPI:1801826755
Name:HARKELL, MARY S (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:S
Last Name:HARKELL
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 1:3818 SHORESIDE CIR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-2308
Mailing Address - Country:US
Mailing Address - Phone:813-264-2271
Mailing Address - Fax:
Practice Address - Street 1:3818 SHORESIDE CIR
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-2308
Practice Address - Country:US
Practice Address - Phone:813-264-2271
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW76731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000793996OtherAPWU
MIFL33624OtherBCBS MICHIGAN
FLZ084HOtherBCBS FL
NYN21Q9OtherEMPIRE BCBS
FLP00202519Medicare ID - Type UnspecifiedRAILROAD MEDICARE
NYN21Q9OtherEMPIRE BCBS