Healthcare Provider Details

I. General information

NPI: 1629050711
Provider Name (Legal Business Name): MARYLOU FOSTER BIASOTTO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 01/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 OMEGA DR BLDG J
NEWARK DE
19713-6020
US

IV. Provider business mailing address

1521 CONCORD PIKE SUITE 103
WILMINGTON DE
19803-3642
US

V. Phone/Fax

Practice location:
  • Phone: 302-428-0205
  • Fax: 302-428-1123
Mailing address:
  • Phone: 302-428-0205
  • Fax: 302-428-1123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0000539
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: