Healthcare Provider Details

I. General information

NPI: 1366742835
Provider Name (Legal Business Name): BENJAMIN R. GROOVER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2010
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N MORRISON BLVD SUITE C
HAMMOND LA
70401-2312
US

IV. Provider business mailing address

620 N MORRISON BLVD SUITE C
HAMMOND LA
70401-2312
US

V. Phone/Fax

Practice location:
  • Phone: 985-543-4113
  • Fax: 985-543-4109
Mailing address:
  • Phone: 985-543-4109
  • Fax: 985-543-4109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4997
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4997
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: