MEDICARE: NANCY ANN DEE LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	ISW00184	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	3411-7	OTHER	RI	BLUE CROSS PROVIDER NO.
2	409236	OTHER	RI	BLUE CHIP PROVIDER NUMBER

General Provider Information

NPI Number	:	1144377870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY ANN DEE LICSW

Provider Business Mailing Address
First Line	:	629 SOUTH RD
Second Line	:
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-7618
Country	:	US
Telephone Number	:	401-789-9989
Fax Number	:

Provider Business Practice Location Address
First Line	:	23 NORTH RD
Second Line	:	A25
City	:	WAKEFIELD
State	:	RI
Zip	:	02879-2176
Country	:	US
Telephone Number	:	401-864-6004
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/04/2007
Last Update Date	:	07/08/2007

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Directions to “ NANCY ANN DEE LICSW” Practice Location

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