MEDICARE: MR. ALVIN A ANDERSON SR. 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	3165	LA

General Provider Information

NPI Number	:	1578961082
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALVIN A ANDERSON SR. LCSW

Provider Business Mailing Address
First Line	:	5843 LOUIS PRIMA DR W
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70128-2802
Country	:	US
Telephone Number	:	504-259-8427
Fax Number	:	504-240-6445

Provider Business Practice Location Address
First Line	:	5843 LOUIS PRIMA DR W
Second Line	:
City	:	NEW ORLEANS
State	:	LA
Zip	:	70128-2802
Country	:	US
Telephone Number	:	504-259-8427
Fax Number	:	504-240-6445

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

Provider Enumeration Date	:	12/15/2014
Last Update Date	:	12/15/2014

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