MEDICARE: CAROLINE ELIZABETH JARVIS MSW, 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	103K00000X	Behavior Analyst		LA
2	104100000X	Social Worker	17444	LA
3	171M00000X	Case Manager/Care Coordinator	17444	LA

General Provider Information

NPI Number	:	1770166308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE ELIZABETH JARVIS MSW, LMSW

Provider Business Mailing Address
First Line	:	615 CHEVELLE CT
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-6502
Country	:	US
Telephone Number	:	225-303-0212
Fax Number	:	225-303-0216

Provider Business Practice Location Address
First Line	:	615 CHEVELLE CT
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70806-6502
Country	:	US
Telephone Number	:	225-303-0212
Fax Number	:	225-303-0216

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

Provider Enumeration Date	:	05/02/2021
Last Update Date	:	09/14/2023

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