Healthcare Provider Details

I. General information

NPI: 1659603959
Provider Name (Legal Business Name): MARY CATHERINE LASITER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY CATHERINE MURPHY LMSW

II. Dates (important events)

Enumeration Date: 02/11/2010
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date: 09/05/2019
Reactivation Date: 12/09/2020

III. Provider practice location address

3683 S FIRST ST
JENA LA
71342-6409
US

IV. Provider business mailing address

3683 S FIRST ST
JENA LA
71342-6409
US

V. Phone/Fax

Practice location:
  • Phone: 318-992-2263
  • Fax:
Mailing address:
  • Phone: 318-992-2263
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number10662
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code225500000X
TaxonomyRespiratory/Developmental/Rehabilitative Specialist/Technologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number10062
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: