Healthcare Provider Details

I. General information

NPI: 1497386940
Provider Name (Legal Business Name): LYDIA MITTIE ROBERTS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2235 POYDRAS ST STE A
NEW ORLEANS LA
70119-7561
US

IV. Provider business mailing address

332 RIVER OAKS DR
DESTREHAN LA
70047-3513
US

V. Phone/Fax

Practice location:
  • Phone: 504-814-8001
  • Fax: 504-814-8002
Mailing address:
  • Phone: 504-236-8126
  • Fax: 985-446-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number7385
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: