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NPI Code Detail

MEDICARE: MARY LOU OATES LCSW

MEDICARE: MARY LOU OATES 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 Worker002989CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1005989OTHERCTSOCIAL WORK LICENSE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811935497
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY LOU OATES LCSW
Provider Business Mailing Address
First Line : 32 JUDSON CIR
Second Line :
City : SHELTON
State : CT
Zip : 06484-4611
Country : US
Telephone Number : 203-929-5443
Fax Number :
Provider Business Practice Location Address
First Line : 949 BRIDGEPORT AVE
Second Line :
City : MILFORD
State : CT
Zip : 06460-3142
Country : US
Telephone Number : 203-878-6365
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2006
Last Update Date : 11/22/2013

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