Healthcare Provider Details

I. General information

NPI: 1093868978
Provider Name (Legal Business Name): SHARYN DIANNE ROBERT L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 MOSS LN
HOUMA LA
70360-4080
US

IV. Provider business mailing address

307 HARDING DR
HOUMA LA
70364-2515
US

V. Phone/Fax

Practice location:
  • Phone: 985-857-3615
  • Fax: 985-857-3706
Mailing address:
  • Phone: 985-857-3615
  • Fax: 985-857-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5207
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: