Healthcare Provider Details

I. General information

NPI: 1033839279
Provider Name (Legal Business Name): MARY OKOTH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2022
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 PIER VIEW WAY STE 211
OCEANSIDE CA
92054-2863
US

IV. Provider business mailing address

804 PIER VIEW WAY STE 211
OCEANSIDE CA
92054-2863
US

V. Phone/Fax

Practice location:
  • Phone: 504-233-9546
  • Fax:
Mailing address:
  • Phone: 504-233-9546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW20942
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number132127
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15226
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: