MEDICARE: MS. MARY ELIZABETH ALABACK 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	104100000X	Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063607729
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARY ELIZABETH ALABACK LCSW

Provider Business Mailing Address
First Line	:	3223 E 31ST ST
Second Line	:	SUITE 201
City	:	TULSA
State	:	OK
Zip	:	74105-2452
Country	:	US
Telephone Number	:	918-749-6935
Fax Number	:	918-749-7611

Provider Business Practice Location Address
First Line	:	3223 E 31ST ST
Second Line	:	SUITE 201
City	:	TULSA
State	:	OK
Zip	:	74105-2452
Country	:	US
Telephone Number	:	918-749-6935
Fax Number	:	918-749-7611

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

Provider Enumeration Date	:	09/06/2007
Last Update Date	:	01/07/2015

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