Provider Demographics
NPI:1205062932
Name:CARLISLE, MARY CHI (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CHI
Last Name:CARLISLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:CHI
Other - Last Name:FRANK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16707 WINDSOR PARK DR
Mailing Address - Street 2:
Mailing Address - City:LUTZ
Mailing Address - State:FL
Mailing Address - Zip Code:33549-6848
Mailing Address - Country:US
Mailing Address - Phone:813-367-7733
Mailing Address - Fax:
Practice Address - Street 1:16707 WINDSOR PARK DR
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33549-6848
Practice Address - Country:US
Practice Address - Phone:813-367-7733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW94431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical