Healthcare Provider Details

I. General information

NPI: 1154470425
Provider Name (Legal Business Name): SUSAN G HERROD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29437 HIGHWAY 63 STE.14
CLINTON LA
70722
US

IV. Provider business mailing address

6161 PERKINS RD STE 2C
BATON ROUGE LA
70808-4119
US

V. Phone/Fax

Practice location:
  • Phone: 225-683-5292
  • Fax: 225-683-1310
Mailing address:
  • Phone: 225-769-2770
  • Fax: 225-769-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number2902
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2902
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: