Healthcare Provider Details

I. General information

NPI: 1154994804
Provider Name (Legal Business Name): MARYLOIS P ALTMANN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2021
Last Update Date: 07/21/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 SE OSCEOLA ST
STUART FL
34994-2211
US

IV. Provider business mailing address

2718 SW MARIPOSA CIR
PALM CITY FL
34990-6064
US

V. Phone/Fax

Practice location:
  • Phone: 617-797-6642
  • Fax:
Mailing address:
  • Phone: 617-797-6642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW18738
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: