Provider Demographics
NPI:1487875423
Name:STEVES, MARY R
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:R
Last Name:STEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:R
Other - Last Name:STEVES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW DMIN
Mailing Address - Street 1:17 PACIFIC ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-2753
Mailing Address - Country:US
Mailing Address - Phone:904-825-3637
Mailing Address - Fax:904-825-3637
Practice Address - Street 1:17 PACIFIC ST
Practice Address - Street 2:STE B
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-2753
Practice Address - Country:US
Practice Address - Phone:904-825-8637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00015551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical