MEDICARE: MRS. ELLEN TERESA FOLEY LCSW

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
1	1041C0700X	Clinical Social Worker	44SC00759600	NJ

General Provider Information

NPI Number	:	1013906189
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ELLEN TERESA FOLEY LCSW

Provider Business Mailing Address
First Line	:	7 WANAMASSA POINT ROAD
Second Line	:
City	:	WANAMASSA
State	:	NJ
Zip	:	07712
Country	:	US
Telephone Number	:	732-532-0182
Fax Number	:	732-532-0194

Provider Business Practice Location Address
First Line	:	1075 STEPHENSON AVE
Second Line	:	ATTN:CREDENTIALS OFFICE
City	:	FORT MONMOUTH
State	:	NJ
Zip	:	07703-5000
Country	:	US
Telephone Number	:	732-532-0182
Fax Number	:	732-532-0194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2005
Last Update Date	:	07/08/2007

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