| Neutral Ground Collective | |
|
4035 Washington Ave New Orleans LA 70125-2935 | |
| (435) 491-0561 | |
| Not Available |
| Full Name | Neutral Ground Collective |
|---|---|
| Speciality | Social Worker |
| Location | 4035 Washington Ave, New Orleans, Louisiana |
| Authorized Official Name and Position | Mark Broussard (CLINIC MANAGER) |
| Authorized Official Contact | 4354910531 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Neutral Ground Collective 4035 Washington Ave New Orleans LA 70125-2935 Ph: () - | Neutral Ground Collective 4035 Washington Ave New Orleans LA 70125-2935 Ph: (435) 491-0561 |
| NPI Number | 1467022533 |
|---|---|
| Provider Enumeration Date | 06/30/2021 |
| Last Update Date | 08/11/2022 |
| Certification Date | 08/11/2022 |
| Medicare PECOS PAC ID | 0648653204 |
|---|---|
| Medicare Enrollment ID | O20220815000502 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1467022533 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Mark Broussard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669839445 PECOS PAC ID: 1355724923 Enrollment ID: I20220815000808 |
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