Mary Ellen Stahr LCSW LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

1275 Issued in FL

Legal business name

MARY ELLEN STAHR LCSW LLC

Practice address

3653 Cortez Rd W
Suite 110 H
Bradenton, FL 34210-3168

Phone

(941) 758-1636

Fax

(941) 894-6224

NPI assigned

Apr 23, 2012

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary Ellen Stahr, LCSW

Title

Owner

Phone

(941) 758-1636

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1390780800000",
    "number": "1962769307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3653 CORTEZ RD W",
            "address_2": "SUITE 110 H",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342103168",
            "telephone_number": "941-758-1636",
            "fax_number": "941-894-6224"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3653 CORTEZ RD W",
            "address_2": "SUITE 110 H",
            "city": "BRADENTON",
            "state": "FL",
            "postal_code": "342103168",
            "telephone_number": "941-758-1636",
            "fax_number": "941-894-6224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY ELLEN STAHR LCSW LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-23",
        "last_updated": "2014-01-27",
        "status": "A",
        "authorized_official_last_name": "STAHR",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "ELLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "941-758-1636",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "1275",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "0004477465",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "01128702",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "001713800",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MHN",
            "identifier": "257481",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS/MILITARY ONE SOURCE",
            "identifier": "UAW065769",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Stefanie Martino, BS
• Jeffrey Martins, DDS
• Miranda Marts
• Tetyana Marunchak, MD
• Mary Ann Clark PH D & Associates PA
• Marydine L Lamb PA
• James B Mason
• Robert Mason
• Stacy W. Mason, MFT
• Massage Therapy Connections, LLC

• Clinical Social Worker in Bradenton, FL
• Providers in Bradenton, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.