Provider Demographics
NPI:1861493512
Name:HUGHES, MARYLOU (MSW/LCSW)
Entity Type:Individual
Prefix:DR
First Name:MARYLOU
Middle Name:
Last Name:HUGHES
Suffix:
Gender:F
Credentials:MSW/LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4103 S INDIAN RIVER DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-7766
Mailing Address - Country:US
Mailing Address - Phone:772-464-2489
Mailing Address - Fax:772-461-3782
Practice Address - Street 1:496 MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-5949
Practice Address - Country:US
Practice Address - Phone:772-464-2489
Practice Address - Fax:772-461-3782
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW00002881041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ1095Medicare ID - Type Unspecified