Healthcare Provider Details

I. General information

NPI: 1639365638
Provider Name (Legal Business Name): PATRICIA PERRY LCSW, ACSW, C-SSWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 06/25/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3135 HIGHWAY 1
RACELAND LA
70394-3652
US

IV. Provider business mailing address

PO BOX 6001
THIBODAUX LA
70302-6001
US

V. Phone/Fax

Practice location:
  • Phone: 985-688-3136
  • Fax:
Mailing address:
  • Phone: 985-688-3136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2163
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number2163
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: