Provider Demographics
NPI:1336157346
Name:GRAMMER, MARY BARCLAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BARCLAY
Last Name:GRAMMER
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 1:248 DAN HEAD ROAD
Mailing Address - Street 2:
Mailing Address - City:POCAHONTAS
Mailing Address - State:TN
Mailing Address - Zip Code:38061-4220
Mailing Address - Country:US
Mailing Address - Phone:731-646-0065
Mailing Address - Fax:731-646-0071
Practice Address - Street 1:248 DAN HEAD ROAD
Practice Address - Street 2:
Practice Address - City:POCAHONTAS
Practice Address - State:TN
Practice Address - Zip Code:38061-4220
Practice Address - Country:US
Practice Address - Phone:731-646-0065
Practice Address - Fax:731-646-0071
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSC5803104100000X
TN31801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN7241190OtherAETNA
MSG00678588Medicaid
TN2040477OtherCIGNA
TN3155253OtherBCBS
TN3922628Medicare ID - Type Unspecified