Healthcare Provider Details

I. General information

NPI: 1740651017
Provider Name (Legal Business Name): MARY ELIZABETH SALES M.S.W., L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2015
Last Update Date: 10/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1713 US HIGHWAY 441 N SUITE E
OKEECHOBEE FL
34972-1900
US

IV. Provider business mailing address

1713 US HIGHWAY 441 N SUITE E
OKEECHOBEE FL
34972-1900
US

V. Phone/Fax

Practice location:
  • Phone: 561-312-8615
  • Fax:
Mailing address:
  • Phone: 561-312-8615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW00002736
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: