Provider Demographics
NPI:1306984430
Name:WHEELER, MARY MARGARET (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:MARGARET
Last Name:WHEELER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:MARGARET
Other - Last Name:WHEELER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:601 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:WILDWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34785-3828
Mailing Address - Country:US
Mailing Address - Phone:352-391-8852
Mailing Address - Fax:
Practice Address - Street 1:601 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:WILDWOOD
Practice Address - State:FL
Practice Address - Zip Code:34785-3828
Practice Address - Country:US
Practice Address - Phone:352-391-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0051311041C0700X
FL97341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3263871OtherCIGNA
FLZ01QHOtherBCBSFL
FL1306984430OtherTRI CARE
FL1306984430OtherVALUE OPTIONS
FL001974800Medicaid
FL0000000OtherMHNET
FLD1738ZMedicare UPIN