| 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 |
|---|---|
| Provider Enumeration Date | 07/14/2009 |
| Last Update Date | 07/14/2009 |
| Medicare PECOS PAC ID | 7012069156 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1922015403 PECOS PAC ID: 6204988348 Enrollment ID: I20090721000128 |
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