Healthcare Provider Details

I. General information

NPI: 1619704368
Provider Name (Legal Business Name): CHRISTINE W BRASSEAUX LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2024
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 SAM RUSHING RD
BATON ROUGE LA
70816-2000
US

IV. Provider business mailing address

9213 MASON DR.
DENHAM SPRINGS LA
70726-2755
US

V. Phone/Fax

Practice location:
  • Phone: 225-773-6077
  • Fax:
Mailing address:
  • Phone: 225-773-6077
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9858
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: