MEDICARE: MRS. SHARON PATRICK WETHERFORD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041S0200X	School Social Worker	2682	LA

General Provider Information

NPI Number	:	1265704175
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SHARON PATRICK WETHERFORD LCSW

Provider Business Mailing Address
First Line	:	4336 NORTH BLVD STE 201
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3920
Country	:	US
Telephone Number	:	225-490-5480
Fax Number	:	225-490-5482

Provider Business Practice Location Address
First Line	:	4336 NORTH BLVD STE 201
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3920
Country	:	US
Telephone Number	:	225-490-5480
Fax Number	:	225-490-5482

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/08/2012
Last Update Date	:	05/20/2021

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