Healthcare Provider Details

I. General information

NPI: 1962433102
Provider Name (Legal Business Name): NADINE M FACIANE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23664 CARDINAL COVE
MANDEVILLE LA
70448
US

IV. Provider business mailing address

PO BOX 1225
MANDEVILLE LA
70470-1225
US

V. Phone/Fax

Practice location:
  • Phone: 985-624-4121
  • Fax: 985-624-4123
Mailing address:
  • Phone: 985-624-4121
  • Fax: 985-624-4123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number5188
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: