Healthcare Provider Details

I. General information

NPI: 1790908119
Provider Name (Legal Business Name): MONICA RENEE VINCENT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4615 GOVERNMENT ST BUILDING 2
BATON ROUGE LA
70806-5820
US

IV. Provider business mailing address

914 FLORA LANE
BATON ROUGE LA
70810
US

V. Phone/Fax

Practice location:
  • Phone: 225-925-1906
  • Fax: 225-925-1972
Mailing address:
  • Phone: 225-925-1906
  • Fax: 225-925-1972

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4601
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4601
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: