MEDICARE: DIMOND B DECUIR LMSW

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	104100000X	Social Worker	17629	LA

General Provider Information

NPI Number	:	1588599179
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIMOND B DECUIR LMSW

Provider Business Mailing Address
First Line	:	11361 N 99TH AVE STE 402
Second Line	:
City	:	PEORIA
State	:	AZ
Zip	:	85345-5459
Country	:	US
Telephone Number	:	602-650-1212
Fax Number	:	602-636-5283

Provider Business Practice Location Address
First Line	:	3455 FLORIDA ST STE 400
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-3764
Country	:	US
Telephone Number	:	225-256-6604
Fax Number	:	225-256-2553

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

Provider Enumeration Date	:	06/15/2026
Last Update Date	:	06/15/2026

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