Provider Demographics
NPI:1356775837
Name:WHARTON, MARY AMANDA (LICSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:AMANDA
Last Name:WHARTON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:354 GIVENS LN
Mailing Address - Street 2:
Mailing Address - City:BERKELEY SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:25411-6549
Mailing Address - Country:US
Mailing Address - Phone:304-268-4782
Mailing Address - Fax:
Practice Address - Street 1:354 GIVENS LN
Practice Address - Street 2:
Practice Address - City:BERKELEY SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:25411-6549
Practice Address - Country:US
Practice Address - Phone:304-268-4782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP029433481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical