Roger Smith, Lcsw Llc | |
14317 Hickory Dr Ponchatoula LA 70454-6653 | |
(985) 974-8172 | |
(985) 386-0826 |
Full Name | Roger Smith, Lcsw Llc |
---|---|
Speciality | Social Worker |
Location | 14317 Hickory Dr, Ponchatoula, Louisiana |
Authorized Official Name and Position | Roger M Smith (OWNER) |
Authorized Official Contact | 9859748172 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Roger Smith, Lcsw Llc 14317 Hickory Dr. Ponchatoula LA 70454-6653 Ph: (985) 974-8172 | Roger Smith, Lcsw Llc 14317 Hickory Dr Ponchatoula LA 70454-6653 Ph: (985) 974-8172 |
NPI Number | 1447489224 |
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Provider Enumeration Date | 07/14/2009 |
Last Update Date | 07/14/2009 |
Medicare PECOS PAC ID | 7012069156 |
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Medicare Enrollment ID | O20090721000137 |
Identifier | Type | State | Issuer |
---|---|---|---|
1447489224 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
104100000X | Social Worker | 5099 (Louisiana) | Primary |
Provider Name | Roger Smith |
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Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1922015403 PECOS PAC ID: 6204988348 Enrollment ID: I20090721000128 |
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