MEDICARE: MS. MATTIE SKYE NOGAYE 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	15077	SC

General Provider Information

NPI Number	:	1639214646
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MATTIE SKYE NOGAYE LCSW

Provider Business Mailing Address
First Line	:	119 CONGO CT
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-7038
Country	:	US
Telephone Number	:	818-590-6262
Fax Number	:

Provider Business Practice Location Address
First Line	:	119 CONGO CT
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-7038
Country	:	US
Telephone Number	:	818-590-6262
Fax Number	:

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

Provider Enumeration Date	:	02/20/2007
Last Update Date	:	05/26/2026

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