Healthcare Provider Details

I. General information

NPI: 1740428655
Provider Name (Legal Business Name): ROLAND MARK FRYOU LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2009
Last Update Date: 02/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7407A SAINT BERNARD HWY
ARABI LA
70032-1832
US

IV. Provider business mailing address

7407A SAINT BERNARD HWY
ARABI LA
70032-1832
US

V. Phone/Fax

Practice location:
  • Phone: 504-278-7401
  • Fax: 504-278-7475
Mailing address:
  • Phone: 504-278-7401
  • Fax: 504-278-7475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number3122
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: