Lisa K Broussard, LCSW008306 is a medicare enrolled "Social Worker - Clinical" provider in Jasper, Georgia. Her current practice location is
27 S Main St, Jasper, Georgia. You can reach out to her office (for appointments etc.) via phone at
(678) 230-5164.
Lisa K Broussard is licensed to practice in Georgia (license number CSW008306) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1952045338.
Healthcare Provider's Profile
Full Name | Lisa K Broussard |
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Gender | Female |
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Speciality | Social Worker - Clinical |
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Location | 27 S Main St, Jasper, Georgia |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1952045338
- Provider Enumeration Date: 04/22/2022
- Last Update Date: 07/03/2023
Medicare PECOS Information:
- PECOS PAC ID: 5890168769
- Enrollment ID: I20230224001178
Medical Identifiers
Medical identifiers for Lisa K Broussard such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1952045338 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
101YM0800X | Counselor - Mental Health | LMSW009255 (Georgia) | Secondary |
1041C0700X | Social Worker - Clinical | CSW008306 (Georgia) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Lisa K Broussard is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Lisa K Broussard, LCSW008306 27 S Main St, Jasper, GA 30143-1600 Ph: (678) 230-5164 | Lisa K Broussard, LCSW008306 27 S Main St, Jasper, GA 30143-1600 Ph: (678) 230-5164 |
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