| Doctor Name: | MARY KATHERINE LILLY |
| NPI Number: | 1285013888 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LICSW |
| License Number: | DP00940388 |
| Business Practice Address: | 908 Scarbro Road Scarbro, WV - 25917 |
| Business Phone Number: | 3045742905 |
| Business Fax Number: | 3044655486 |
| Mailing Address: | P O Box 337, 908 Scarbro Road SCARBRO |
| State: | WV |
| Postal Code: | 25917 |
| Phone Number: | 3045742905 |
| Fax Number: | 3044651518 |
| NPI Enumeration Date: | 05/28/2015 |
| NPI Last Update Date: | 05/28/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | DP00940388 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WV |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |