MEDICARE: MAGGIE ROBERT 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	1041C0700X	Clinical Social Worker	13447	LA

General Provider Information

NPI Number	:	1417578840
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAGGIE ROBERT LCSW

Provider Business Mailing Address
First Line	:	4200 ESSEN LN
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-2158
Country	:	US
Telephone Number	:	225-765-1456
Fax Number	:

Provider Business Practice Location Address
First Line	:	4200 ESSEN LN
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-2158
Country	:	US
Telephone Number	:	225-765-1456
Fax Number	:

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

Provider Enumeration Date	:	04/27/2020
Last Update Date	:	11/29/2021

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Directions to “ MAGGIE ROBERT LCSW” Practice Location

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