| Dina Broussard Lcsw Llc | |
|
119 Edward Dr Sunset LA 70584-5429 | |
| (337) 207-1434 | |
| Not Available |
| Full Name | Dina Broussard Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 119 Edward Dr, Sunset, Louisiana |
| Authorized Official Name and Position | Dina Broussard (OWNER) |
| Authorized Official Contact | 3372071434 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dina Broussard Lcsw Llc 119 Edward Dr Sunset LA 70584-5429 Ph: (337) 207-1434 | Dina Broussard Lcsw Llc 119 Edward Dr Sunset LA 70584-5429 Ph: (337) 207-1434 |
| NPI Number | 1598287468 |
|---|---|
| Provider Enumeration Date | 07/12/2017 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 4789950726 |
|---|---|
| Medicare Enrollment ID | O20171019000786 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1598287468 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 6039 (Louisiana) | Primary |
| Provider Name | Dina Broussard |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1275675043 PECOS PAC ID: 5698041630 Enrollment ID: I20171019000875 |
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