Provider Demographics
NPI:1164585907
Name:SCOTT, MARY ANN K (LICSW)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:K
Last Name:SCOTT
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 MINSTERIAL RD.
Mailing Address - Street 2:STABLEWOOD
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879
Mailing Address - Country:US
Mailing Address - Phone:401-783-4960
Mailing Address - Fax:
Practice Address - Street 1:724 MINISTERIAL RD
Practice Address - Street 2:STABLEWOOD
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-4815
Practice Address - Country:US
Practice Address - Phone:401-783-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW002331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9396-3OtherBCBS
RI809009396Medicare ID - Type Unspecified