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1900 S. Acadian Thruway Baton Rouge LA 70808 | |
| (225) 336-8708 | |
| (225) 336-8703 |
| Full Name | |
|---|---|
| Speciality | Voluntary or Charitable |
| Location | 1900 S. Acadian Thruway, Baton Rouge, Louisiana |
| Authorized Official Name and Position | David C. Aguillard (EXECUTIVE DIRECTOR) |
| Authorized Official Contact | 2253368770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
P.o. Box 1668 1900 S. Acadian Thruway Baton Rouge LA 70821-1668 Ph: (225) 336-8770 | 1900 S. Acadian Thruway Baton Rouge LA 70808 Ph: (225) 336-8708 |
| NPI Number | 1336467877 |
|---|---|
| Provider Enumeration Date | 05/07/2010 |
| Last Update Date | 05/07/2010 |
| Medicare PECOS PAC ID | 1355539396 |
|---|---|
| Medicare Enrollment ID | O20101217000460 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336467877 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
| 251V00000X | Voluntary Or Charitable | (* (Not Available)) | Primary |
| Provider Name | Alfred L Robelot |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1871744003 PECOS PAC ID: 5890975056 Enrollment ID: I20110207000103 |
| Provider Name | Mary F Uter |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336456938 PECOS PAC ID: 6103000104 Enrollment ID: I20110418000073 |
| Provider Name | Stephanie Gordon |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1003234840 PECOS PAC ID: 0840416301 Enrollment ID: I20140718002200 |
| Provider Name | Lydia D Ledet |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922026392 PECOS PAC ID: 1052539798 Enrollment ID: I20140821002422 |
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