Provider Demographics
NPI:1063607729
Name:ALABACK, MARY ELIZABETH (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARY ELIZABETH
Middle Name:
Last Name:ALABACK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3223 E 31ST ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2452
Mailing Address - Country:US
Mailing Address - Phone:918-749-6935
Mailing Address - Fax:918-749-7611
Practice Address - Street 1:3223 E 31ST ST
Practice Address - Street 2:SUITE 201
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2452
Practice Address - Country:US
Practice Address - Phone:918-749-6935
Practice Address - Fax:918-749-7611
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200482290AMedicaid