| Jennifer R. Vines Lcsw Inc | |
|
601 W Saint Mary Blvd Suite 400 Lafayette LA 70506-3568 | |
| (337) 235-5088 | |
| (337) 261-1152 |
| Full Name | Jennifer R. Vines Lcsw Inc |
|---|---|
| Speciality | Social Worker |
| Location | 601 W Saint Mary Blvd, Lafayette, Louisiana |
| Authorized Official Name and Position | Jennifer Rogers Vines (OWNER) |
| Authorized Official Contact | 3372355088 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jennifer R. Vines Lcsw Inc 601 W Saint Mary Blvd Suite 400 Lafayette LA 70506-3568 Ph: (337) 235-5088 | Jennifer R. Vines Lcsw Inc 601 W Saint Mary Blvd Suite 400 Lafayette LA 70506-3568 Ph: (337) 235-5088 |
| NPI Number | 1164604609 |
|---|---|
| Provider Enumeration Date | 11/27/2007 |
| Last Update Date | 11/27/2007 |
| Medicare PECOS PAC ID | 3072401082 |
|---|---|
| Medicare Enrollment ID | O20040310000075 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164604609 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 3064 (Louisiana) | Primary |
| Provider Name | Jennifer R Vines |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1629047402 PECOS PAC ID: 2567455629 Enrollment ID: I20040406000190 |
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