MEDICARE: DANIEL OMOAYO 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	CSW00760	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1912942202	OTHER	RI	UBH
2	1104847946	OTHER	RI	THE PROVIDENCE CENTER NPI
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912942202
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL OMOAYO LCSW

Provider Business Mailing Address
First Line	:	1115 W CHESTNUT ST
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-7501
Country	:	US
Telephone Number	:	508-580-4691
Fax Number	:	508-580-5162

Provider Business Practice Location Address
First Line	:	1115 W CHESTNUT ST
Second Line	:
City	:	BROCKTON
State	:	MA
Zip	:	02301-7501
Country	:	US
Telephone Number	:	508-223-4691
Fax Number	:	508-580-5162

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

Provider Enumeration Date	:	06/19/2006
Last Update Date	:	07/27/2012

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