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NPI Code Detail

MEDICARE: MARY E. SKIDMORE LCSW

MEDICARE: MARY E. SKIDMORE 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
11041C0700XClinical Social Worker1488OK

General Provider Information

NPI Number : 1396743597
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY E. SKIDMORE LCSW
Provider Business Mailing Address
First Line : 2201 LANEWAY CIR
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73159-5827
Country : US
Telephone Number : 405-713-5876
Fax Number : 405-713-5786
Provider Business Practice Location Address
First Line : 2129 SW 59TH ST
Second Line : MYHRO CENTER
City : OKLAHOMA CITY
State : OK
Zip : 73119-7024
Country : US
Telephone Number : 405-713-5876
Fax Number : 405-713-5786
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/12/2005
Last Update Date : 10/28/2011

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