| Myra Gulotta Lcsw Llc | |
|
215 Rue Fontaine Lafayette LA 70508-5742 | |
| (337) 577-5203 | |
| (337) 806-9339 |
| Full Name | Myra Gulotta Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 215 Rue Fontaine, Lafayette, Louisiana |
| Authorized Official Name and Position | Myra B Gulotta (OWNER) |
| Authorized Official Contact | 3375775203 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Myra Gulotta Lcsw Llc 215 Rue Fontaine Lafayette LA 70508-5742 Ph: (337) 577-5203 | Myra Gulotta Lcsw Llc 215 Rue Fontaine Lafayette LA 70508-5742 Ph: (337) 577-5203 |
| NPI Number | 1043046907 |
|---|---|
| Provider Enumeration Date | 09/09/2024 |
| Last Update Date | 09/09/2024 |
| Certification Date | 09/09/2024 |
| Medicare PECOS PAC ID | 2264973858 |
|---|---|
| Medicare Enrollment ID | O20240925004637 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1043046907 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Myra B Gulotta |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1417701806 PECOS PAC ID: 5799226387 Enrollment ID: I20240925004660 |
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