| Miriam Wholean Lcsw Llc | |
|
19 Burrows St Mystic CT 06355-2446 | |
| (860) 334-3080 | |
| Not Available |
| Full Name | Miriam Wholean Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 19 Burrows St, Mystic, Connecticut |
| Authorized Official Name and Position | Miriam Wholean (OWNER) |
| Authorized Official Contact | 8603343080 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Miriam Wholean Lcsw Llc 19 Burrows St Mystic CT 06355-2446 Ph: (860) 334-3080 | Miriam Wholean Lcsw Llc 19 Burrows St Mystic CT 06355-2446 Ph: (860) 334-3080 |
| NPI Number | 1336769736 |
|---|---|
| Provider Enumeration Date | 04/26/2020 |
| Last Update Date | 04/26/2020 |
| Certification Date | 04/26/2020 |
| Medicare PECOS PAC ID | 3375964224 |
|---|---|
| Medicare Enrollment ID | O20200601001053 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336769736 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Miriam R Wholean |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1386098069 PECOS PAC ID: 6305103599 Enrollment ID: I20171124000185 |
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