Provider Demographics
NPI:1629050711
Name:BIASOTTO, MARYLOU FOSTER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARYLOU
Middle Name:FOSTER
Last Name:BIASOTTO
Suffix:
Gender:F
Credentials:LCSW
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Other - First Name:
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Mailing Address - Street 1:1521 CONCORD PIKE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803-3642
Mailing Address - Country:US
Mailing Address - Phone:302-428-0205
Mailing Address - Fax:302-428-1123
Practice Address - Street 1:25 OMEGA DR BLDG J
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-6020
Practice Address - Country:US
Practice Address - Phone:302-428-0205
Practice Address - Fax:302-428-1123
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2017-01-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DEQ1-00005391041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical