Healthcare Provider Details

I. General information

NPI: 1982618302
Provider Name (Legal Business Name): BONNIE GUMPERT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19404 N 10TH ST
COVINGTON LA
70433-8892
US

IV. Provider business mailing address

19404 N 10TH ST
COVINGTON LA
70433-8892
US

V. Phone/Fax

Practice location:
  • Phone: 985-871-1380
  • Fax: 985-871-1387
Mailing address:
  • Phone: 985-871-1380
  • Fax: 985-871-1387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2354
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: