Mary Ann Shires, LCSW

Individual provider Active NPI Clinical Social Worker · Maxwelton, WV

NPI 1679747893 · NPPES record last updated Mar 31, 2020

Key facts

NPI
1679747893
Entity type
Individual (NPI type 1)
Primary specialty
Clinical Social Worker 1041C0700X
License
CP00080591 (WV)
Practice address
804 Industrial Park Rd
Maxwelton, WV 24957-8066
Phone
(304) 497-0500
NPI assigned
Apr 18, 2008
Sex
Female
Sole proprietor
No

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
CP00080591WVMDClinical Social Worker

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X CP00080591 WV Yes

Addresses

Primary practice location

804 Industrial Park Rd
Maxwelton, WV 24957-8066

Mailing address

1305 Webster Rd
Summersville, WV 26651-1125
Phone (304) 872-6503

Other providers in Maxwelton, WV

All providers in Maxwelton, WV · Clinical Social Worker in West Virginia

Sources for this page

Verify at the official NPI Registry.