Provider Demographics
NPI:1962401836
Name:TAYLOR, MARY A (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:A
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1605 WHITE CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:N CHESTERFLD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5449
Mailing Address - Country:US
Mailing Address - Phone:804-621-2650
Mailing Address - Fax:804-748-5077
Practice Address - Street 1:800 BLANTON AVE STE 102
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23221-3603
Practice Address - Country:US
Practice Address - Phone:804-621-2650
Practice Address - Fax:804-276-8195
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0904004301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA800002554Medicare PIN