Provider Demographics
NPI: | 1265519219 |
---|---|
Name: | ESCOTT, MARGOT (MARGOT ESCOTT) |
Entity type: | Individual |
Prefix: | MS |
First Name: | MARGOT |
Middle Name: | |
Last Name: | ESCOTT |
Suffix: | |
Gender: | F |
Credentials: | MARGOT ESCOTT |
Other - Prefix: | MS |
Other - First Name: | MARGOT |
Other - Middle Name: | |
Other - Last Name: | ESCOTT |
Other - Suffix: | |
Other - Last Name Type: | Professional Name |
Other - Credentials: | LCSW |
Mailing Address - Street 1: | 1782 IMPERIAL GOLF COURSE BLVD |
Mailing Address - Street 2: | C-103 |
Mailing Address - City: | NAPLES |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 34110-1046 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 239-434-6558 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 1782 IMPERIAL GOLF COURSE BLVD |
Practice Address - Street 2: | C-103 |
Practice Address - City: | NAPLES |
Practice Address - State: | FL |
Practice Address - Zip Code: | 34110-1046 |
Practice Address - Country: | US |
Practice Address - Phone: | 239-434-6558 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2006-11-01 |
Last Update Date: | 2016-05-05 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
FL | SW0001708 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
FL | 260246272 | Other | TAX ID NUMBER |
FL | 650015816 | Medicare UPIN | |
FL | Z2166 | Medicare ID - Type Unspecified | MEDICARE |