Provider Demographics
NPI:1619861242
Name:MARY ANN S WALL LCSW LLC
Entity type:Organization
Organization Name:MARY ANN S WALL LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WALL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:267-566-0536
Mailing Address - Street 1:58 NATHAN CT
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-3430
Mailing Address - Country:US
Mailing Address - Phone:267-566-0536
Mailing Address - Fax:215-672-1172
Practice Address - Street 1:58 NATHAN CT
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3430
Practice Address - Country:US
Practice Address - Phone:267-566-0536
Practice Address - Fax:215-672-1172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty