Provider Demographics
NPI:1336152305
Name:DAVIES, MARYLEIN F (LCSW)
Entity Type:Individual
Prefix:
First Name:MARYLEIN
Middle Name:F
Last Name:DAVIES
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 1:2579 WESTERN TRAILS BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1578
Mailing Address - Country:US
Mailing Address - Phone:512-441-4445
Mailing Address - Fax:512-899-3576
Practice Address - Street 1:2579 WESTERN TRAILS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1578
Practice Address - Country:US
Practice Address - Phone:512-441-4445
Practice Address - Fax:512-899-3576
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX37571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00S47CMedicare ID - Type Unspecified