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NPI Code Detail

MEDICARE: MR. DONALD W MOTT LCSW-R

MEDICARE: MR. DONALD W MOTT LCSW-R
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
11041C0700XClinical Social WorkerR080284-1NY

General Provider Information

NPI Number : 1215990015
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DONALD W MOTT LCSW-R
Provider Business Mailing Address
First Line : 222 MULLIN ST
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-3618
Country : US
Telephone Number : 315-408-7238
Fax Number :
Provider Business Practice Location Address
First Line : 482 BLACK RIVER PKWY
Second Line :
City : WATERTOWN
State : NY
Zip : 13601-2416
Country : US
Telephone Number : 315-782-1777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2006
Last Update Date : 07/02/2013

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