Healthcare Provider Details

I. General information

NPI: 1811158165
Provider Name (Legal Business Name): TARA R CHARPENTIER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MEDICAL PARK DR
LAFAYETTE LA
70508-4500
US

IV. Provider business mailing address

PO BOX 428
CROWLEY LA
70527-0428
US

V. Phone/Fax

Practice location:
  • Phone: 337-534-0490
  • Fax: 337-534-0493
Mailing address:
  • Phone: 337-788-1328
  • Fax: 337-788-4770

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number10163
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: