Provider Demographics
NPI:1144994161
Name:FUTRELL, MAMIE M (LCSW, LISW-CP)
Entity type:Individual
Prefix:DR
First Name:MAMIE
Middle Name:M
Last Name:FUTRELL
Suffix:
Gender:F
Credentials:LCSW, LISW-CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 BUCKEYE LN
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:DE
Mailing Address - Zip Code:19977-5246
Mailing Address - Country:US
Mailing Address - Phone:484-542-9883
Mailing Address - Fax:
Practice Address - Street 1:955 FOREST ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-3401
Practice Address - Country:US
Practice Address - Phone:302-760-9736
Practice Address - Fax:302-329-3107
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2023-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0011940251S00000X, 1041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE87-1982892Medicaid